BILATERAL HYDRONEPHROSIS

AND URETERECTASIS TO THE

URETEROVESICAL JUNCTION

Jennifer Pittman
DMS Student
DMS 497
Fall 2014

CASE HISTORY

Zero day, African American

Male
Weight: 2830 grams
Labs: none available
Reason for exam: abnormal ultrasound
in utero
Symptoms: polyuria

SONOGRAPHIC
FINDINGS

Figure 1: Transverse measurement

of the left kidney

SONOGRAPHIC
FINDINGS
Click icon to add picture

Figure 2: Sagittal
measurement of the left
kidney

SONOGRAPHIC
FINDINGS

Figure 3: Sagittal view of the

left kidney showing moderate
hydronephrosis and dilated
left ureter

SONOGRAPHIC
FINDINGS
Click icon to add picture

Figure 4: Sagittal view showing no

color Doppler flow in the left ureter

SONOGRAPHIC
FINDINGS
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Figure 5: Transverse plane

showing dilated distal left ureter
near the insertion into the bladder

SONOGRAPHIC
FINDINGS

Figure 6: Transverse plane

showing dilated distal right ureter
near the insertion into the bladder

SONOGRAPHIC
FINDINGS
Click icon to add picture

Figure 7: Transverse measurement

of the right kidney

SONOGRAPHIC
FINDINGS
Click icon to add picture

Figure 8: Sagittal measurement

of the right kidney

SONOGRAPHIC
FINDINGS

Figure 9: Sagittal view of the right

kidney showing moderate
hydronephrosis and dilated right ureter

SONOGRAPHIC
FINDINGS

Figure 10: Measurement of renal

pelvic diameter of 9.8 mm suggesting
moderate hydronephrosis

SONOGRAPHIC
FINDINGS

Figure 11: Animation

comparing a normal ureter to
an obstructed ureter.

SONOGRAPHIC
FINDINGS

Figure 12: Animation

demonstrating different
grades of hydronephrosis.

DIAGNOSIS

Grade III Bilateral Hydronephrosis

Moderate 9 15 mm
Normal ureter is 5 mm

Ureterectasis to the ureterovesical

junction
Bilateral primary megaureter

DIAGNOSIS

Bilateral
Hydronephrosis
Incidence:

Ureterectasis to
Ureterovesical
Junction Incidence:

Affects about 1 in 100

babies

Normally bilateral
Occurs four times
more in boys
Most often seen
prenatally in second
trimester

Normally bilateral
Occurs almost twice as
frequently in boys
Most common neonatal
abdominal mass

DIAGNOSIS
Common Clinical
Symptoms:

Asymptomatic
Bloody urine
Fever
Polyuria
Pain
Vomiting

Common Sonographic
Findings:
Dilated anechoic renal
pelvis and calices
Dilated anechoic ureter
Narrowing of distal ureter
Increased peristalsis of
ureter
Variable amount of
parenchyma isoechoic to
liver
No color or spectral
Doppler

CONCLUSION
Compare and Contrast with Literature
Treatment options:
Normally resolve before birth
25% require nephrectomy or nephrostomy
With renal function continually follow up
Ureteral reimplantation
Voiding cystourethrogram and diuretic
scintigraphy

REFERENCES

University of Michigan Health System. Vesicoureteral reflux. Ann

Arbor, MI. 2014. Available from:
http://www.med.umich.edu/1libr/urology/vesicoureteral.htm
Rumack CM, Wilson SR, Charboneau JW, Levine D. Diagnostic
ultrasound.4th edition. Philadelphia, PA: Mosby, Inc; 2011. Chapter 54,
The Pediatric Kidney and Adrenal Glands p.1852-1856. Chapter 39,
The Fetal Urogenital Tract p.1369-1373.
De Bruyn, Rose. Pediatric ultrasound: how, why, and when. Elsevier
ltd. 2nd edition. 2010. Chapter 3, The Renal Tract p.46.
Childrens Hospital of Philadelphia. Ureterovesical junction (UVJ)
obstruction. Philadelphia, PA. 2011. Available from:
http://www.chop.edu/healthinfo/ureteral-vesical-junctionobstruction.html
Cox LA, Lattimer JK, Uson AC. Journal of American medical
association. Hydronephrosis in infants and children. 205(6): 323-326.
Available from: http://jama.jamanetwork.com/article.aspx?
articleid=340166

REFERENCES
Bostons Childrens Hospital. Hydronephrosis. Boston, MA.
Available from: http://www.childrenshospital.org/healthtopics/conditions/hydronephrosis
Newson L. Congenital urogenital malformations. 2013.
Available from:
http://www.patient.co.uk/doctor/congenital-urogenitalmalformations
Siegel, MJ. Pediatric ultrasound. 4th edition. Philadelphia,
PA. 2011. Chapter 11, Urinary Tract p.393-396.
VanDervoort K, Lasky S, Sethna C, Frank R, Vento S, ChoiRosen J, Goilav B, Trachtman H. Clinical medicine:
pediatrics. Hydronephrosis in infants and children: natural
history
and risk factors for persistence in children
followed by a medical service. 2009; 20(1): 6370.
Available from: file:///C:/Users/sony/Downloads/f_1781-