What does dilatation of the pelvis mean?
The pelvis is a funnel into which urine is collected before exiting into the ureter. If the outflow is somehow obstructed or urine is periodically thrown back from the bladder, the pelvis is stretched. In the fetus and newborn, a slight dilation is a variant of the norm: the urinary tract is still immature, the tone of the ureters is low, and the volume of urine is relatively large. Doctors estimate the size of the pelvis in millimeters at a specific period and monitor the dynamics. If the expansion increases or the expansion of the calyces joins, we are talking about hydronephrosis.
- The pelvis collects urine in front of the ureter
- Dilation is physiological in newborns
- Assess size and dynamics rather than a single measurement
- Enlargement of the calyces indicates hydronephrosis
- Can be on one or both sides
Reasons
The most common cause of persistent pyelectasis is a narrowing at the junction of the pelvis and the ureter, due to which urine flows more slowly. The second most common is vesicoureteral reflux, when when urinating, urine is thrown back to the kidney. In boys, it is important to exclude the posterior urethral valve: this condition requires early surgery. There are also duplication of the ureter, ureterocele, and neurogenic bladder. In addition, in infants, the pelvis may appear dilated when the bladder is full - in this case, ultrasound is repeated after urination.
- Narrowing of the ureteropelvic segment
- Vesicoureteral reflux
- Posterior urethral valve in boys
- Duplication of the ureter and ureterocele
- Neurogenic bladder
- Full bladder during examination
How does it manifest itself?
Mild pyeelectasis usually does not manifest itself in any way and remains a finding on ultrasound. Symptoms appear when the outflow is severely impaired or when an infection is attached. In infants, this is primarily unexplained fever, restlessness, refusal to eat, poor weight gain, and sometimes vomiting. Older children may experience lower back or abdominal pain, especially after drinking a large amount of liquid, and frequent painful urination. In boys, an alarming sign is a weak, intermittent stream of urine.
- Most often asymptomatic
- Unreasonable fever in an infant
- Restlessness and crying when urinating
- Lower back or abdominal pain in older children
- Weak stream of urine in boys
- Recurrent urinary tract infections
Survey and observation
The main method is ultrasound of the kidneys and bladder, which is repeated over time: the first examination after birth is usually carried out not on the first day, when the child is physiologically dehydrated, but later. Be sure to monitor the urine test, and if an infection is suspected, a culture is done. With significant or increasing dilation, voiding cystography is prescribed to exclude reflux and a radioisotope study to assess kidney function and the degree of outflow disturbance. The frequency of examinations is determined by a pediatric urologist; you do not need to change the plan yourself.
- Ultrasound of the kidneys and bladder in dynamics
- Estimation of sizes before and after urination
- Urinalysis and urine culture
- Void cystography for suspected reflux
- Radioisotope study of kidney function
- Regular examinations by a pediatric urologist
Treatment: when observation is sufficient
In most cases of mild and moderate pyelectasia, treatment is not required: repeated ultrasounds and monitoring urine tests are sufficient, and the expansion decreases on its own as the child grows. For vesicoureteral reflux and repeated infections, the doctor may prescribe a prophylactic antibiotic in a low dose. Surgery is needed if outflow disturbance is confirmed, dilation increases, kidney function decreases, or episodes of pyelonephritis recur. Modern interventions are well tolerated and allow you to save the kidney. The decision is always made by a pediatric urologist after weighing all the data.
- Observation and repeated ultrasounds for mild cases
- Monitoring urine tests for early detection of infection
- Antibiotic prophylaxis for reflux as prescribed by a doctor
- Operation with increasing expansion and decrease in function
- Timely treatment of urinary tract infections
- Observation until adolescence for anomalies
