Pediatric Urology

[mtjanb]

Hello,
I am 27 weeks pregnant with a second son. Six weeks ago at our Level II ultrasound, we were informed the baby has pyelectasis and that both kidneys were dialated to about twice expected size. Doctors didn't seem too worried and said baby could grow out of it by delivery.

Today, at our follow up ultrasound, it seemed condition had worsened and this time paperwork gave the term pelviectasis with calyectasis. Kidneys are dialated to 6mm and 8mm rather than typical 4mm. Doctor said the ureters are likely kinked or blocked. He said kidneys and bladder otherwise looked normal. This doctor would not otherwise comment on whether this was a serious or not-so-serious condition. He didn't suggest the condition would go away by birth but instead suggested we just have to wait and have baby examined after birth. He said he wouldn't refer us to a pediatric urologist since there's nothing to be done in utero and we'll just have to wait and see once baby is born. He suggested surgery might be needed but not necessarily right after birth.

My worry is that after today's appointment, it appears they think there is an actual problem as opposed to this just being an abnormality that today's sensitive equipment can pick up on. I am grateful for being alerted to this so we can make sure the baby is properly tested after birth.

Can you please shed some light on this condition and how a blocked ureter will impact our baby down the road - e.g., damage to kidneys and/or bladder, lifestyle problems, surgery? I've looked on the Internet in hopes of finding information yet could not find anything that gave practical information.

Also - should my 3 year old son be tested? We never had a Level II ultrasound with him other than during the amnio at 17 weeks. He seems normal other than the fact that he doesn't seem to urinate very often. I've attributed that to either not drinking enough or resistance to potty training (knows how but refuses to use toilet).

Thank you for any help you can offer. I am trying to stay calm but I cannot help but worry about my new baby and how this problem will impact his life and treatments for it. Being pregnant at age 41 has made me worry non-stop!

[UroDoc]

The dilatation could be cause by congenital ureteropelvic junction obstruction. Also in a male posterior urethral vales can cause urinary obstruction. Both of these conditions are correctable after birth. It still may be the sensitivity of the equipment being used or the skill and consistency of the operator. I wouldn't worry. In regards to your other child it would probable make you feel better if he was checked and since an Ultrasound poses no threat you might want to discuss it with your pediatrician.

[mtjanb]

Hello again,
I'm now at 35 weeks and just had another level II ultrasound. Left kidney is now borderline normal at 8mm, but right kidney is at 17mm and I was told norm is 7mm.

This time the doctor (a different one than last time) told me they really can't tell on an ultrasound whether kidneys appear normal. I was surprised since last time they said both kidneys and bladder looked normal.

I was also told my amniotic fluid is a bit low. I'm scheduled for another ultrasound in two weeks at which point they may recommend delivery, I think due to the low fluid level.

Urodoc - any other comments or input? I'm worried as it seems the baby "won't grow out of this".

Thanks.

[UroDoc]

in general it is not out of the ordinary for your amnionic fluid to be low at 35 weeks. it may just be a little below the normal range for 35 weeks. there is a scale called amnionic fluid index that they use. this scale shows a decrease in fluid as you reach the last trimester. it is hard for me to comment on the amnionic fluid without knowing what the amnionic fluid index number is. you should voice your concerns to your ob/gyn,he or she has the information on you available that can best answer your questions. generally after birth, the baby usually undergoes an ultrasound to check the kidneys when they had this kidney problem in utero.it is very common for this problem to resolve itself after birth and this problem is seen more commonly in utero in male fetuses.good luck!

[mtjanb]

Hello,
Thought I'd post an update. Hoping URODOC or anyone else can comment as it has been very helpful in the past.

At 37 weeks pregnant, they did another level II ultrasound and found my amniotic fluid to be low enough that they recommended early delivery. Also, the perinatologist report stated the hydronephrosis had worsened, they suggested the kidneys had reflux, and they recommended early delivery so the baby could be surgically treated.

That night the baby was born via c-section (I had had a previous c-section so that part was expected). The baby was with me in recovery for about an hour and then moved to the nursery for a bath while I was moved to my room. Turns out the nurses were watching him and noticed he was having some difficulties breathing, so they then moved him to the special nursery, and by the next morning he was transported to a nearby hospital for their NICU due to underdeveloped lungs and heart.

He spent the next two weeks in the NICU, and we were told all complications were due to his being early. His difficulties were surprising to many since he wasn't really that early. Once his breathing and heart were stabilized, they did a VCUG on him and found no reflux or blockage. The pediatric urologist said baby would have an ultrasound after release from NICU.

The baby is now five months and there's been no change in the kidney dilation. Specialist said left kidney is a grade 2 and right kidney is a 3 minus. Two months ago, he had a renal scan and we were told there were no obvious obstructions and there's every reason to believe he will grow out of this.

Yesterday, we had another ultrasound by the specialist. He said there's still no big change - the right side may have gotten a bit worse, though it's hard to measure. This time he suggested surgery. He said it's always a balance and somewhat of a guess between making sure surgery is really needed (versus if the child outgrows it) and risking damage to the kidney. The specialist scheduled us for another renal scan and formal ultrasound in two months. If there's still no change, he recommends surgery on just the right side. He still believes the left side will resolve itself.

I asked what they would fix, since the renal scan showed nothing and we were told if the baby had a clear renal scan then we could relax and most likely the baby would outgrow this. The specialist said the renal scan was a bit inconclusive and the report suggested a partial obstruction.

He said the surgery is only about 1.5 hours and requires just an overnight hospital stay. I know the specialist is relaxed about it but I sure am not. The baby is strong and healthy and at least I've had many months to get used to the possibility of surgery.

I really like our pediatric specialist but think I may seek a second opinion as I believe that's what most people say is wise before undergoing surgery. But I sure don't want to step on anyone's toes, especially the specialist who will do the surgery. Thoughts on getting a second opinion?

Any advice or comments would greatly be appreciated. I need all the help I can get!