Antenatal Hidronefroz Sebebi ile Başvuran 1 Aylık Erkek Olgu
Özet
Antenatal ultrasonografide (USG) sol böbreğinde genişleme saptanan 1 aylık bir erkek bebek, doğum sonrası çocuk ürolojisi polikliniğine sevk edilmiştir. Klinik değerlendirmesinde idrar yolu enfeksiyonu öyküsü olmayan, sağlıklı ve normal idrar yapabilen hastanın, yapılan ardışık USG takiplerinde sol böbreğinde ileri derecede pelvikalisiyel dilatasyon (Grade IV PKD) ve parankim kalınlığında azalma izlenmiştir. Tek taraflı izole hidronefroz tablosu nedeniyle öncelikle üreteropelvik bileşke darlığı (UPBD) ön tanısı düşünülerek amoksisilin profilaksisi başlanmıştır. Takibinde progresyon saptanması üzerine 2. ayda gerçekleştirilen MAG-3 böbrek sintigrafisinde sol böbreğin diferansiyel fonksiyonunun %30.3'e düştüğü ve diüretik yanıtının olmadığı tespit edilerek cerrahi endikasyon konulmuştur. Hastaya retrograd piyelografi eşliğinde açık Anderson-Hynes piyeloplasti operasyonu uygulanmış, dar üreter segmenti çıkarılarak anastomoza JJ stent yerleştirilmiştir. Operasyon sonrası ilk 2 yıl boyunca hastanın USG ile 3, 6 ve 12. aylarda takip edilmesi ve ameliyat sonrası 1. yılda kontrol amacıyla MAG-3 sintigrafisinin tekrarlanması planlanmıştır.
A 1-month-old male infant, who had left kidney enlargement detected on antenatal ultrasonography (USG), was referred to the postnatal pediatric urology clinic. In the clinical evaluation of the patient, who had no history of urinary tract infection and was a healthy infant with normal urination, consecutive postnatal USG follow-ups revealed severe pelvicalyceal dilatation (Grade IV PKD) and decreased parenchymal thickness in the left kidney. Due to the presentation of isolated unilateral hydronephrosis, ureteropelvic junction obstruction (UPJO) was primarily considered as the preliminary diagnosis, and amoxicillin prophylaxis was initiated. Upon detecting progression during follow-up, a MAG-3 renal scintigraphy performed in the second month demonstrated that the differential function of the left kidney had decreased to 30.3% with no diuretic response, establishing the indication for surgery. The patient underwent open Anderson-Hynes pyeloplasty accompanied by retrograde pyelography, during which the narrow ureteral segment was excised and a JJ stent was placed across the anastomosis. For the postoperative period, follow-up with USG at 3, 6, and 12 months during the first 2 years and a control MAG-3 scintigraphy at the first postoperative year were planned.
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