Conditions + Treatments

Treatments for Hydronephrosis in Children

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Contact the Department of Urology

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Receiving news about your baby having kidney swelling may be worrisome. At Boston Children's Hospital, we view the diagnosis as a starting point for care and treatment. Once we have identified the cause of your child's condition, we can begin the treatment process with the goal of returning her to good health.

If your baby is diagnosed with hydronephrosis, here are a few helpful things to keep in mind:

  • In many of the children who are diagnosed before birth, the condition disappears spontaneously before they are born or soon after.
  • In children who have mild or, sometimes, moderate hydronephrosis, kidney function isoften unharmed and the condition may resolve itself over a period of time after delivery.
  • If surgery is called for, we have a very high success rate
  • Only a handful of cases require treatment, or fetal intervention, while a baby is in the womb. For those babies who require treatment, it is nearly always provided after birth.

After considering the nature and cause of the hydronephrosis, doctors will decide between recommending observation or surgery.

Fetal intervention

In very rare instances, prenatal hydronephrosis is so severe that it puts the fetus at risk. This usually means the obstruction is in the child's urethra, blocking drainage of the bladder and both kidneys. In turn, this results in a dangerously low amount of amniotic fluid (a condition called oligohydramnios).

Observation

If postnatal testing shows your child has mild to moderate hydronephrosis, your doctor may recommend allowing time for the condition to correct itself on its own. Your child may receive a low dose of antibiotics to prevent infection. Repeat ultrasounds will let us check for improvement.

Observation has become the accepted method of treatment in children with mild hydronephrosis. Even in children with moderate hydronephrosis, if kidney function is not lost and kidneys are growing well, observation can allow the condition to correct itself.

Surgery

Only in severe cases would surgery be needed. The goal of the operation is to reduce the swelling and pressure in the kidney by restoring the free flow of urine.

The most common surgical procedure is pyeloplasty. This repairs the most common type of blockage that causes hydronephrosis: ureteropelvic junction obstruction (UPJ). In pyeloplasty, the surgeon will remove the narrowed or obstructed part of the ureter. Then, the healthy portion is reconnected to the kidney's drainage system. After open surgery (small incision over the kidney), children usually stay in the hospital for about two to three days. They heal in two to three weeks. The success rate is about 95 percent. 

Other surgical treatments may be recommended for your child, depending on what's causing the hydronephrosis and how severe it is. To learn more about these, see the Boston Children's treatment sections for the following: ureteropelvic junction obstruction, vesicoureteral reflux (VUR), posterior urethral valves (PUV) and ureteroceles.

Robot-assisted and minimally invasive surgery

We are a nationally recognized pioneer in robotic-assisted surgery. Boston Children's was the first pediatric hospital to use a surgical robot, beginning in 2001.  

This innovative tool is used for about half of the pyeloplasties performed by our urological team.

A robot-assisted pyeloplasty is a minimally invasive laparoscopic procedure. With the use of a tiny camera, surgeons operate using very thin instruments inserted into three or four small incisions. Robot-assisted pyeloplasty removes an obstructed section of the ureter and reattaches the healthy portion to the kidney's drainage system.

Robotic surgery can offer a number of benefits as compared to traditional (open) surgery, including:

  • less discomfort after the operation
  • smaller scars on the belly
  • a shorter hospital stay—usually 24 to 48 hours
  • quicker recovery
  • earlier return to full activities

Note: Even if pyeloplasty is recommended for your child, a robot-assisted procedure may or may not be suitable. Your doctor will recommend the best options for your child.  

Coping and support

We understand that you may have a lot of questions when your child is diagnosed with hydronephrosis. Will it affect my child long term? What do we do next? In addition to our   website, we offer a number of other resources to help you and your family through this difficult time.

Patient education: Our nurses are on hand to walk you through your child's treatment and help answer any questions you may have.

Parent to parent: Do you want to talk with someone whose child has been treated for hydronephrosis? We can often put you in touch with other families who have been through the same experience you and your child are facing and can share their story.

Social work: One important member of our pediatric urology team is a dedicated social work professional who has helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis; dealing with financial difficulties; and finding temporary housing near the hospital if your family is traveling to Boston from another area.

On our For Families and Patients website, you can read all you need to know about:

  • Getting Here – directions to Boston Children's
  • Accommodations
  • The hospital experience
  • Other resources that are available for your family

In addition, two leading national groups provide additional information on hydronephrosis and may help connect you with parents across the country:

  • The National Kidney Foundation: This nonprofit, volunteer organization is dedicated to improving the health and well-being of anyone affected by kidney disease, preventing kidney and urinary tract diseases and promoting organ transplantation.
  • The American Association of Kidney Patients: This nonprofit organization is founded “by kidney patients for kidney patients” and is dedicated to educating and improving the well-being of people with kidney ailments.
Hydrophrenosis

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

Boston Children's Hospital 300 Longwood Avenue, Boston, MA 02115 617-355-6000 | 800-355-7944

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