Hydronephrosis, which translates to "water in the kidney," refers to a condition in which the renal pelvis expands, usually due to an obstruction in the normal flow of urine through the kidney, leading to urine accumulation. Until a few decades ago, hydronephrosis couldn't be detected before the appearance of secondary symptoms like lower back pain, urinary infection, or kidney insufficiency. Nowadays, modern imaging technologies allow for diagnosis and even the identification of the underlying causes in the early stages of the disease. Thanks to early diagnosis, in most cases, corrective measures can be taken before irreversible deterioration in kidney function occurs.
Hydronephrosis is a common finding (around 2%-4%) in prenatal ultrasound examinations. Common causes include dilation in the renal pelvis outlet and dilation in the ureter's entry point into the bladder. In the latter case, the ultrasound examination will also reveal ureteral dilation. The condition may also occur due to vesicoureteral reflux, where urine flows back from the bladder into the kidney. Another, although less common, cause is posterior urethral valves in boys.
In most cases, surgical intervention will not be required, and the fetus will continue to be monitored, so as to identify in advance any problems or complications that might require treatment. In the minority of cases where surgical intervention is required, it is a procedure without complications, yielding positive outcomes. The department's physicians are an integral part of the multidisciplinary team that supports parents from the moment of diagnosis through birth, final diagnosis, and performing surgery if necessary.
The surgery is minimally invasive for removing the blockage, or endoscopic surgery for repairing vesicoureteral reflux. The department's physicians specialize in both techniques, yielding good results with no scars and a short healing time before returning to normal activities.
The Pediatric Urology Department at Shaare Zedek Medical Center was among the pioneers worldwide to adopt a conservative approach in the management of varying degrees of prenatal hydronephrosis rather than surgical intervention in all cases. Today, this is the accepted approach in Western medicine.
