Antenatal Hidronefroz Nedeniyle Başvuran 12 Günlük Kız Olgu
Özet
Bu vaka sunumunda, antenatal 32. haftada sol böbrekte saptanan grade 2 hidroüreteronefroz ve 10 mm üreter çapı nedeniyle yönlendirilen 12 günlük bir kız bebek ele alınmaktadır. Yapılan değerlendirmeler sonucunda hastaya, retrovezikal üreter çapının 7 mm'den büyük olması kriterine dayanarak megaüreter tanısı konmuştur. İlk ayında yapılan kontrol ultrasonografisinde bulgularının stabil kalması ve işeme sistoüretrografisinde vezikoüreteral reflü (VUR) saptanmaması üzerine, olası bir tıkanıklığın belirlenmesi amacıyla MAG-3 renal sintigrafi planlanmıştır. Sintigrafide sol böbrekte fonksiyon kaybı görülmemiş (%50-%50 separe fonksiyon) ancak diüretiğe yanıt vermeyen bir boşalma paterni saptanarak üreterovezikal bileşke obstrüksiyonu (primer obstrüktif megaüreter - POM) tanısı doğrulanmıştır. Antibiyotik profilaksisi altında izlenen hasta, 4 aylıkken ateşli idrar yolu enfeksiyonu (piyonefrit) ve üreter çapının 20 mm'ye yükselmesi tablosuyla başvurmuştur. Akut enfeksiyon tedavisi sonrası, üretere sistoskopi eşliğinde JJ stent yerleştirilmesi denense de kateterizasyon başarısız olmuştur. Bunun üzerine, böbrek fonksiyonlarını korumak ve hızlı dekompresyon sağlamak amacıyla geçici diversiyon yöntemi olarak üreterokutanostomi uygulanmıştır. Takibinde enfeksiyon geçirmeyen ve 13. ayda üreter dilatasyonu gerileyen hastaya, altın standart tedavi olan Cohen antireflüksif üreteroneosistostomi (UNS) operasyonu başarıyla gerçekleştirilmiş ve üreter çapı küçüldüğü için ek bir daraltma işlemine gerek kalmamıştır.
This case report presents a 12-day-old female infant referred due to grade 2 hydroureteronephrosis and a 10 mm ureteric diameter detected in the left kidney at the 32nd gestational week antenatally. Following the evaluations, the patient was diagnosed with megaureter based on the criterion of a retrovesical ureteric diameter larger than 7 mm. Since the findings remained stable on the control ultrasonography performed in her first month and voiding cystourethrography revealed no vesicoureteral reflux (VUR), a MAG-3 renal scintigraphy was planned to determine a potential obstruction. The scintigraphy demonstrated no loss of function in the left kidney (50%-50% differential function) but revealed an drainage pattern non-responsive to diuretics, confirming the diagnosis of ureterovesical junction obstruction (primary obstructive megaureter - POM). While followed under antibiotic prophylaxis, the patient presented at 4 months of age with a febrile urinary tract infection (pyelonephritis) and an increased ureteric diameter of 20 mm. Although cystoscopy-guided JJ stent placement was attempted after acute infection treatment, catheterization failed. Consequently, cutaneous ureterostomy was performed as a temporary diversion method to preserve renal function and provide rapid decompression. The patient remained infection-free during follow-up, and at 13 months, as her ureteric dilatation regressed, she successfully underwent Cohen antireflux ureteroneocystostomy (UNS), the gold standard surgical treatment, without requiring any tapering procedure since the ureteric diameter was suitable.
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