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Urinary and Genital Disorders (Children)

Hydronephrosis

10/24/2008

Question:

My daughter is 11 and has neurofibromatosis. She had a cystic neurofibroma reomved from her thoracic spine (T5-T7) in Feb of this year. She saw a urologist a month after the surgery to ensure there was no damage to the bladder or kidneys from the lesion. Her renal us at that time was normal. She saw the urologist again in Sept and had the renal us repeated. It showed mild hydronephrosis of the left kidney,the left kidney large for her age, and a possible duplicating collection system of the left kidney. The urologist wants to repeat the us in 6 mos. She does have a lot of urgency but no leaking etc. Can the hydronephrosis be related to the original spine lesion? She had a MRI about 3 weeks ago of her thoracic spine and it showed postoperative changes but no clear lesion. Also,it showed some displacement of the spinal cord. Can you explain hydronephrosis in relation to NF and are there symptoms to look for that would indicate progression. Thank you.

Answer:

This is a very difficult question to answer without reviewing the films and examining the patient. Hydronephrosis may be mild, moderate, or severe. If it is severe, then it suggests a significant change that would require subspecialist evaluation. On the other hand, it is possible that the changes are reflective of previous surgical changes. Only a thorough urological evaluation with urodynamics would suffice.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University