Patient's question:
Hydronephrosis in children; How to treat urethral strictureDoctor's answer:
Analysis of Renal Hydronephrosis and Urethral Stricture in Children1. The most common cause or etiology is ureteral stricture, and the most likely location for ureteral stricture is the ureteropelvic junction (UPJ).
2. There are also other factors or etiologies, such as vesicoureteral reflux (VUR). It cannot be ruled out that urethral stricture in your child may cause increased bladder pressure, leading to reflux. However, most cases are due to poor development of the antireflux mechanism in the ureterovesical segment, which is congenital. In summary, these factors or etiologies can be attributed to impaired drainage, preventing the urine produced by the kidneys from being smoothly transported to the bladder, resulting in increased pressure. Over time, the renal pelvis and kidney become progressively larger, which we refer to as "renal hydronephrosis." Some cases of hydronephrosis can be detected during prenatal ultrasound examinations. Some mild cases may not be discovered immediately after birth but may gradually develop symptoms over time: recurrent urinary tract infections, and parents may notice an abdominal mass in the child, which is later confirmed as hydronephrosis.
Consequences of Hydronephrosis
1. Recurrent urinary tract infections.
2. Compression of the renal cortex, leading to thinning over time, which affects kidney function and may progress to renal failure.
Treatment for Hydronephrosis
1. For newborns and infants, as their organs are relatively small, if the hydronephrosis is mild and there are no complications from recurrent infections, conservative observation with regular monitoring may be recommended. Surgical treatment can be considered when the child is older. The most common procedure is pyeloplasty (ureteropelvic junctionoplasty). This surgery is relatively major and requires a longer hospital stay, but the outcomes are generally excellent, and the child recovers well. If reflux is the cause, a vesicoureteral reflux repair may be necessary, which is similar in scope to the above procedure.
2. If the hydronephrosis is severe or accompanied by recurrent infections, surgical treatment should be considered after the infection is controlled. The surgery would be the same as described above.
Urethral Stricture
Urethral strictures can be classified based on their location and nature, and the difficulty of treatment varies significantly. Some may be resolved with a single surgery, while others may have a higher risk of recurrence. Therefore, it is essential to undergo further examinations to clarify the specifics. Urethral strictures are relatively rare compared to hydronephrosis, so it is advisable to seek treatment at a hospital with specialized pediatric surgery for more comprehensive care.
Recommendation: Seek treatment at a specialized pediatric surgery department. Surgical intervention is recommended.
I hope this advice provides some assistance to you.