did not do this step well, it hurt the baby...
Recently, a 12-year-old boy named Liu (a pseudonym) with a "big belly" in Huaxi Pediatric Surgery Department suddenly came to who looked like seven months old "Pregnant woman belly", along the way, the whole family is cautious, for fear of accidentally breaking the belly .
Xiao Liu’s mother told the doctor that her son’s stomach has become bigger and bigger in the past six months, and he can’t even eat, walk, and even dare not participate in sports. The family is terrified and has toured many local hospitals. Because the stomach was so swollen, the doctors had never seen such a serious situation.
When Xiaoliu
was admitted to the hospital for treatment, various examination results showed that Xiaoliu's kidneys were extremely severe hydronephrosis, which was the result of congenital hydronephrosis not treated in time. At the same time, because the belly is almost filled with the extremely dilated kidneys, the doll is swollen and uncomfortable to eat, causing serious malnutrition in the long run.
The black part is the kidney with water
Both kidneys are full of urine, and the kidney parenchyma is as thin as paper, just like two balloons filled with water. Once a fall or an external collision occurs, the kidneys are at risk of rupture at any time, with disastrous consequences.
"In response to Xiao Liu's situation, we underwent nephrostomy (first release the urine) and pyeloplasty in stages to save the kidney. However, we have missed the best time for treatment, although the total renal function is still normal , But the reserve function of the kidneys has been lost, which will have a certain impact on future life." According to his doctor in charge, associate professor Huang Yidong, a fourth-level expert in Pediatric Surgery in West China.
After the hydronephrosis surgery, Xiao Liu’s stomach "flattened back" and his appetite improved a lot.
After learning about the situation with family members, we discovered that Xiao Liu's mother had not undergone formal prenatal checkups . After Xiao Liu was born, his stomach was a little lumpy. Apart from his lack of eating, malnutrition, and lack of exercise, his body seemed to have no other abnormalities. Xiao Liu's parents did not pay much attention to it. The time of treatment was delayed, which gradually led to the present. s consequence.
What exactly is "congenital hydronephrosis"? Why does
become a big belly? How to identify
early?
Today, we invited "Associate Professor Huang Yidong" of Pediatric Surgery of "West China Hospital of Sichuan University" to treat Xiao Liu to talk about congenital hydronephrosis!
One. Big problems dragged out by minor problems
What is congenital hydronephrosis?
Congenital hydronephrosis refers to the dilation of the renal collecting system found by ultrasound screening before and early after birth.
The prevalence of the disease after birth is 1/1500, and the ratio of male to female is about 2:1, and it mostly occurs in the left kidney. Z1z
Associate Professor Huang Yidong said that in the past, medical conditions were poor and prenatal examinations were not timely. Usually, only when the baby’s abdomen appeared obvious masses, or had stomach pain, low back pain, abdominal pain, or even hematuria, he went to the hospital for examination and found hydronephrosis.
and ’s current medical conditions can be found through ultrasound screening before the baby is born. As long as they are treated in time, the baby’s hydronephrosis can be treated well. The key to
is that parents should pay attention to them, conduct regular check-ups, and consciously treat them immediately after finding that the baby has congenital hydronephrosis.
Don't let it go!
2. The severity of hydronephrosis,
may relieve itself
"As long as the parents are careful, Xiao Liu's situation can be completely avoided. As long as regular check-ups and medical treatment are performed, congenital hydronephrosis is not terrible." Associate Professor Huang Yidong pointed out.
now generally through prenatal screening and postpartum intervention for the corresponding treatment of children with congenital hydronephrosis.
● When the mother is 16 to 18 weeks pregnant, the kidneys and urinary system can be seen through ultrasound. If there is obvious hydronephrosis, it can be found immediately.
● When the mother is pregnant to 28 weeks, it is the most sensitive time to evaluate the urinary system, because it can see whether there is water in the kidney and ureter, and it can be identified immediately when there is a problem.
So if obstetricsWhen the doctor discovers the problem, in addition to telling the parents the first time, he will also seek the opinions of the pediatric urologist. The purpose is to assess whether the baby’s hydronephrosis is serious, and it will not have a big impact on the kidney function in the future, and whether it can save the kidneys. Can you keep the doll?
Generally speaking, there will be three assessment results:
01, mild: 80% of children are likely to relieve themselves
. Prenatal examination found that the fetus has hydronephrosis within 9 mm. After birth, it is good to insist on regular follow-up review. According to relevant statistics, 80% of children with mild hydronephrosis may relieve themselves before delivery. The red box in the
table is the main reference index
Click to view the larger picture
Associate Professor Huang Yidong told us that, in fact, the positive rate of fetal hydronephrosis detected by prenatal ultrasound is 1%~2%, and 100 mothers have 1 out of ultrasound. ~2 fetuses have hydronephrosis. In the later stage of mild hydronephrosis, there is a great chance that they can recover on their own. Parents do not need to worry too much.
02. Severe: If you are "surgery due to disease"
after birth, the standard ultrasound follow-up and observation will find that the accumulation of water continues to aggravate and meet the surgical standard. After completing the relevant imaging examinations and sub-renal function examinations, the most suitable surgical method will be arranged according to the children's age, weight and water accumulation.
03, combined with other congenital malformations: very rare
very few fetuses may be combined with other serious developmental malformations, including the following problems: bilateral severe dilation, bilateral dysplasia of the kidney, progressive bilateral dilatation with amniotic fluid reduction And lung dysplasia. (In short, there are some serious cases) After a professional pediatric urologist, nephrologist, and obstetrician conduct a multidisciplinary consultation (MDT), combined with the wishes of the family, a prudent decision whether to stop the pregnancy is made together. Z1z
Associate Professor Huang Yidong also said that this situation is very rare.
3. The doctor reminds: Don’t panic too much
Regular check-ups are the key!
01. Regular obstetrics do not delay
Associate Professor Huang Yidong reminds: you must regularly and regularly obstetrics, after discovering problems (such as hydronephrosis), you must find a professional pediatric urologist for consultation and evaluation.
Don't ignore the discovery of hydronephrosis. If you are delayed after birth, without examination and treatment, it will easily lead to more serious diseases and various complications. Xiao Liu in the previous article is a living example.
02. Don’t panic after discovering the problem
Associate Professor Huang Yidong reminds everyone that most of the fetal hydronephrosis found in prenatal examinations is mild, although we think it is very light, only a few millimeters, but parents may be anxious if they don’t understand the situation.
and some doctors’ words are more serious: "Your baby has hydronephrosis, and the kidneys may be broken." The parents didn’t know it, and thought that the baby’s kidneys were “extremely important,” and the result was confused. The fetus was induced, which caused a lifelong regret.
Look at this case.
has a 32-week pregnant mother. Ultrasound examination found that the fetus’s left hydronephrosis was 8 mm. She was very nervous. At that time, she was terribly scared. Some uremia and miscarriage appeared in her mind, as if the baby had already It's gone. Associate professor
Huang Yidong said that, in fact, the condition is mild hydronephrosis, which can be relieved by oneself after birth. It does not require intervention, has little effect on the kidneys, and basically has no effect on children's total renal function.
Finally, under the guidance of a professional doctor, the fetus has undergone prenatal examinations without other combined abnormalities, followed up regularly after birth, and came to the hospital for ultrasound examination in the second month. The water has dropped to 5 mm. Re-examination in the third month. The stagnant water has disappeared on its own.
In general,
is detectable, preventable and curable
. Adhere to regular check-ups without delay or panic.
congenital hydronephrosis is not terrible at all!
expert profile
is committed to the treatment of children with urinary developmental malformations, tumors, and stones in minimally invasive surgery, and Da Vinci robot-assisted laparoscopic surgery. Good at kidney, hydroureter, duplication of kidney, urinary tract stones in children, penile deformity, cryptorchidism, hypospadiasAnd other diseases. He has joined Professor Huang Lugang's "Diagnosis" Pediatric Urology Popularization Workshop team, contributing wisdom and strength to the health of young patients.
Professor Huang Lugang is good at the diagnosis and surgical treatment of various pediatric urinary diseases such as congenital hypospadias, renal and ureteral malformations, and penile urethral malformations. He has rich clinical experience in the surgical treatment of traumatic urethral injuries in children and has unique skills and experience. Especially have a deep understanding of hypospadias.
Reference materials:
[1] "Expert consensus on early management of congenital hydronephrosis in children in China" (Nephrology Group of Pediatric Branch of Shanghai Medical Association, Pediatric Surgery Branch of Shanghai Medical Association, Pediatrics Hospital of Fudan University, Capital Medical Department Beijing Children’s Hospital Affiliated to the University, National Children’s Medical Center. Expert consensus on early management of Chinese children with congenital hydronephrosis. Chinese Journal of Practical Pediatrics. 2018,33(2):81-88)
[2].EAU GUIDELINES ON PAEDIATRIC UROLOGY 2020 (C. Radmayr (Chair), G. Bogaert,, HS Dogan, JM Nijman (Vice-chair), MS Silay, R. Stein, S. TekgülGuidelines Associates: LA't Hoen, J. Quaedackers, N. Bhatt)
Source of this article: Chengdu Commercial Daily, Sichuan famous doctor
Original title: 12-year-old baby has a belly as big as a pregnant woman in July! Doctor Huaxi: Just because of a parent's negligence, it may affect the child's life! Responsible editor: Li Xiaorong
