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How to treat bilateral hydroureteronephrosis?

Q: My son is a week old. We had a real time B-Mode ultrasonography of the kidneys, ureters and bladder and the results are: cortex of both kidneys appeared normal, right renal pelvis measured 8 mm, left renal pelvis measured 6 mm, dilatation of both ureters seen, bladder appeared normal. Impression: bilateral hydroureteronephrosis. What should be our next step? How serious is this?

A:A week old infant with ultrasonogram study and proven bilateral hydroureteronephrosis needs to be evaluated by a urologist preferably a Paediatric Urologist. Urologist with the assistance of a Radiologist would perform very specific imaging test (without exposing the infant to excessive radiation from indiscrete usage of tests) to address the underlying congenital anomalies. These anomalies like posterior urethral valve and less commonly vesicoureteral reflux disease do result in urinary tract outlet obstruction causing the above findings. The next step would be to undertake voiding cystourethogram to diagnose the above-mentioned anomalies. The infant would also require a test called diuretic renography to assess his underlying kidney function. While awaiting the diagnosis and correction of the anomaly, the infant can benefit from being started on prophylactic antibiotics since these conditions do make them prone to recurrent urinary tract infections. Most of these anomalies are surgically correctable and have excellent long-term prognosis with close monitoring including urine infection and kidney function over the following years.

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