CONGENITAL HYDRONEPHROSIS: CLINICAL COURSE, DIAGNOSTIC APPROACHES, AND SURGICAL TREATMENT OPTIONS
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Congenital hydronephrosis is one of the most common developmental anomalies of the urinary tract in neonates and infants, characterized by dilatation of the renal pelvis and calyces due to impaired urinary outflow. Early detection and appropriate management are essential to prevent progressive renal dysfunction and irreversible parenchymal damage. The etiology of congenital hydronephrosis is multifactorial, involving genetic predisposition, anatomical obstruction, and functional abnormalities at the ureteropelvic junction. This paper provides a comprehensive overview of the clinical progression, diagnostic strategies, and surgical treatment options for congenital hydronephrosis in pediatric patients. The study discusses the significance of prenatal ultrasonography for early identification, postnatal imaging modalities such as diuretic renography and magnetic resonance urography, and differential diagnosis with other congenital renal anomalies. Special emphasis is placed on grading systems like the Society for Fetal Urology SFU classification, which aid in determining the severity of obstruction and guiding treatment decisions. The review also evaluates current surgical approaches, including open pyeloplasty, laparoscopic pyeloplasty, and robot-assisted procedures, in terms of their indications, outcomes, and postoperative complications. Additionally, the paper highlights the role of conservative management in mild cases, monitoring protocols, and long-term renal function preservation strategies. Overall, understanding the natural history and clinical behavior of congenital hydronephrosis allows clinicians to tailor individualized treatment plans, optimize surgical timing, and minimize the risk of renal impairment in affected children
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