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Both Kidneys Shows Dilated Pelvicalyceal System With Dilated Tortuous Ureters. Treatment?

Posted on Thu, 7 Mar 2013

Question: fetal mri at 21 weeks ga : Both kidneys shows dilated pelvicalyceal system with pelvic diameter measuring 3.8 mm with dilated tortuous ureters on either side. Urinary bladder is elongated distended extending up to the upper abdomen.

what is the severity of this.
can it be automatically resolved. how long it could take.
pregnancy risk?
treatment options?
will baby have normal life after post birth.

Please explain in detail.

Thanks.

Answered by Dr. Dr. Rakhi Tayal (2 hours later)

Hello,
Thanks for posting your query.
The findings of the MRI are suggestive of fetal bladder outlet obstruction. Because the baby cannot empty the bladder, the baby’s bladder subsequently becomes very large and distended. Also, because the amniotic fluid is essentially composed of the baby’s urine beyond the middle of the second trimester, the bag of waters dries up.
In your case since there is moderate dilatation of pelvicalyceal system, the obstruction may be partial.
If the amniotic fluid volume is adequate then there are less chances of further complications.
It is often difficult to pin point the cause of obstruction before delivery. It can cause fatal complications like pulmonary hypoplasia if associated with a decreased amniotic fluid volume.
Serial ultrasound scans are required to assess the severity of problem and its progress.
Vesico amniotic shunts ( Surgical option) may be considered if the pregnancy is beyond 24 weeks.
If the liquor volume is gradually decreasing and in pregnancy less than 24 weeks, termination of pregnancy may be considered if the fetal kidneys damage s progressive.
Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (8 hours later)

Thanks Doctor.
Please review the below information.
This is twin pregnancy noted with intertwine membrane.
The age is now 22 weeks.
one fetal has this issue.
Liquor is adequate for both.
All other things brain, abdomen, face, chest, heart, brain, spine, extremities, - are normal for both.
termination is not suggested by regular doctor with the above info.
can surgery be safe here...
Please advise your observations and predictions on the whole. thanks.

Answered by Dr. Dr. Rakhi Tayal (13 hours later)

Hello.
Thanks for writing again.
Since it is a twin pregnancy and liquor is adequate, surgery is not immediately required. In case the renal calyceal dilatation increases or the liquor volume decreases then active management is needed. Till then you need to have serial ultrasound scans for regular monitoring.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (37 hours later)

Thanks doctor. Just final clarifications,
Regular doctor advises
to consider posterior urethral valves. correlated with USG. - Please brief.
Continue as is with close monitoring and correct this issue after post birth. - will this baby have normal life in all aspects ?
thanks.

Answered by Dr. Dr. Rakhi Tayal (34 hours later)

The cause of dilated bladder is suggested to be posterior urethral valve which can be corrected surgically after birth.
Close ultrasound monitoring is needed. If the fetal progress is good then this can be corrected after birth and the baby can have a normal life.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (11 days later)

Hi Doctor,

Attached the new ultrasound scans. Please review and confirm all are normal.
Also what is FOC value in ultrasound. thanks.

Answered by Dr. Dr. Rakhi Tayal (13 hours later)

I have seen all the reports attached with the query. The ultrasound scan shows a normal study. Both the fetuses are growing well.
However a detailed report given by the radiologist will help in a better evaluation.
FOC refers to Fronto Occipital circumference of the head.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Rakhi Tayal (14 days later)

Hi Doctor, attached new scans . Please review and comment. Thanks.

Answered by Dr. Dr. Rakhi Tayal (51 minutes later)

The attached scan photos appear to be normal. A detailed report of radiologist is needed to know about the condition of kidneys and the amount of liquor.
Regards.

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar