Hydronefrose door obstructie thv de overgang vh nierbekken naar de ureter:
- Anatomische factor
- Peristaltiek probleem
Asymptomatisch, koliekproblemen of voedingsstoornissen (bij neonaat door massa-effect op de
gastro-intestinale tractus)
Diagnostiek: echografie + renogram met diuretische stimulatie
Behandeling: 50% benigne = afwachtende houding of chirurgische correctie
Hydro-ureteronefrose
= gedilateerde ureter tgv een probleem thv de vesico-ureterale junctie:
- Reflux, obstructie of combinatie = functionele weerslag behandeld
- Gestoord anatomisch beeld = geen functionele weerslag niet behandeld
Diagnose: echografie, cystografie (contraststof retrograad in de blaas via catheter) en renogram
Functionele niermassa meten: isotopenscan met DMSA vormen van hydronefrose onderscheiden
+ behandeling
Geen obstructie Obstructie
Geen reflux Afwachten Re-implantatie
Reflux Zie hoofdstuk reflux Re-implantatie
Vesico-ureterale reflux
= abnormaal terugvloeien van urine vanuit de blaas naar de bovenste urinewegen (ureters en nieren)
, Fysiologie:
- Normaal: schuin verloop doorheen de blaaswand (muscularis en mucosa) toename
intravesicale druk = ureter afgesloten en er kan geen urine meer terugvloeien
- Vesico-ureterale reflux (primair): inplanting van de ureter is onvoldoende schuin
- Vesico-ureterale reflux (secundair): disfunctie van de urinaire tractus, oorzaken:
o Neuropathe blaas
o Blaasfunctiestoornissen door detrusorinstabiliteit en detrusor-sfincter discoördinatie
o Infravesicale obstructie uropathie zoals posterieure urethrakleppen en ectope
uretercoeles
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