The aim of this paper is to address the dilemmas of the paediatric surgeon when facing an isolated, unilateral, congenital hydronephrosis and discuss the strategic options for the management of this condition. Congenital hydronephrosis, the most commonly diagnosed uropathy in children, is usually a benign and self-resolving condition. Nonobstructive hydronephrosis does not require operative treatment, while timely treatment is imperative for obstructive hydronephrosis before significant renal damage ensues. Managing congenital hydronephrosis is a challenging task. Thirty-two children with unilateral, isolated hydronephrosis and nonobstructed renography curves were followed up for 3 years. On the initial evaluation according to the grade of hydronephrosis: 22.6% were grade I, 54.8% grade II and 22.6% grade III. After 12 months of follow-up: 30% were grade I, 51.5% grade II and 18.5% grade III, respectively. After the three-year follow-up, there were no hydroneproses greater than grade II. The mean value of the separate GFR of the affected kidney at initial evaluation was 42.83%, and 40.33% after three years. In three children the treatment was converted from conservative to surgical. Nonobstructive, congenital hydronephrosis is a benign condition not requiring any medical treatment, but aggressive observation is indicated.
Duplications in the urinary collecting system and pyeloureteral junction obstruction (PUJO) are common, but the simultaneous presence of both anomalies is rarely encountered. In duplicate incomplete systems, PUJO usually affects the lower moiety of the kidney.We present a case of a 2-year old boy with left bifid renal pelvis and hydronephrosis of the lower moiety of the kidney.
Intercondylar fracture of the distal humerus is an extremely rare injury in children, especially in those under 8 years of age. To our knowledge, there have been around 50 reported cases of this fracture type in children in the English literature, 12 of which involved children under 8 years of age.
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