C section scar adhesions symptoms. C-Section Scar Adhesions: Symptoms, Causes, and Treatment
What are the symptoms of C-section scar adhesions? How do adhesions develop after a C-section? What are the risks and complications of C-section adhesions? How are C-section adhesions diagnosed and treated?
Defining C-Section Scar Adhesions
An adhesion is a band of scar tissue that joins two internal body surfaces that are not usually connected. After a C-section, adhesions can form between the uterus, abdominal wall, and other organs or tissues. These adhesions develop as the body attempts to repair itself following the surgical incision.
Causes of C-Section Scar Adhesions
Adhesions commonly form after any type of pelvic or abdominal surgery, including a C-section. Up to 93% of people who undergo abdominal surgery go on to develop adhesions. Adhesions can also occur in 10% of people who have never had surgery, often due to infection, endometriosis, or other types of trauma or inflammation in the abdomen or pelvis.
Symptoms of C-Section Scar Adhesions
Although many adhesions are painless and do not cause complications, adhesions can lead to a range of problems, including infertility, painful intercourse, pelvic pain, and bowel obstruction. Adhesion-related disorder (ARD) is a group of symptoms that may occur due to adhesions, and can include chronic abdominal pain, bowel dysfunction, and emotional distress.
Diagnosing C-Section Scar Adhesions
Diagnosing the chronic pain of adhesions can be challenging, as standard imaging tests like x-rays, CT scans, and ultrasounds cannot detect the presence of adhesions. The only way to definitively diagnose adhesions is through a diagnostic laparoscopy, a minimally invasive surgical procedure that allows the doctor to visually inspect the abdominal cavity.
Treating C-Section Scar Adhesions
Adhesions can be treated through open or laparoscopic (keyhole) surgery, known as adhesiolysis. During this procedure, the adhesions are cut and separated using a scalpel or electrical current. However, adhesions have a high rate of recurrence, with up to 70% of people developing new adhesions after the initial surgery.
Preventing C-Section Scar Adhesions
To reduce the risk of adhesions after a C-section, doctors may use adhesion-barrier products or techniques during the surgery to keep tissues separated as they heal. Additionally, avoiding multiple or extensive abdominal surgeries can help minimize the risk of developing adhesions.
Living with C-Section Scar Adhesions
For those who experience chronic pain and other complications due to adhesions, managing the condition can be challenging. Pain management, physical therapy, and addressing any emotional or mental health impacts may be important parts of the treatment plan.
What is the most common cause of adhesions after a C-section? Adhesions commonly form after any type of abdominal or pelvic surgery, including a C-section. Up to 93% of people who undergo abdominal surgery go on to develop adhesions.
Can adhesions cause infertility after a C-section? Yes, adhesions can lead to infertility by affecting the function of the reproductive organs, such as the ovaries and fallopian tubes.
How are C-section scar adhesions treated? Adhesions can be treated through open or laparoscopic (keyhole) surgery, known as adhesiolysis, where the adhesions are cut and separated. However, adhesions have a high rate of recurrence, with up to 70% of people developing new adhesions after the initial surgery.
What are the long-term complications of C-section scar adhesions? Adhesions can lead to a range of long-term complications, including chronic pelvic pain, bowel obstruction, and infertility. Adhesion-related disorder (ARD) is a group of symptoms that may occur due to adhesions, including chronic abdominal pain, bowel dysfunction, and emotional distress.
Can adhesions cause pain years after a C-section? Yes, adhesions can cause symptoms, including pain, for months or even years after the initial C-section surgery. The chronic pain associated with adhesions can be difficult to diagnose and manage.
How can C-section scar adhesions be prevented? To reduce the risk of adhesions after a C-section, doctors may use adhesion-barrier products or techniques during the surgery to keep tissues separated as they heal. Avoiding multiple or extensive abdominal surgeries can also help minimize the risk of developing adhesions.
Is it possible to live with C-section scar adhesions? For those who experience chronic pain and other complications due to adhesions, managing the condition can be challenging. Pain management, physical therapy, and addressing any emotional or mental health impacts may be important parts of the treatment plan.
Adhesions – Better Health Channel
An adhesion is a band of scar tissue that joins two internal body surfaces that are not usually connected. Organs or tissues within the body stick (adhere) to other internal surfaces.
Adhesions develop as the body attempts to repair itself. This normal response can occur after surgery, infection, injury (trauma) or radiation. Adhesions may appear as thin sheets of tissue similar to plastic wrap, or as thick fibrous bands.
Adhesions can affect the female reproductive organs (ovaries, fallopian tubes), the bowel, the area around the heart, the spine and the hand. They can cause a range of problems including infertility, dyspareunia (painful intercourse), pelvic pain and bowel obstruction or blockage. Adhesions can also lead to a complex set of problems called adhesion-related disorder (ARD).
Adhesions are a widespread problem. Up to 93 per cent of people who have abdominal surgery go on to develop adhesions. Abdominal adhesions also occur in 10 per cent of people who have never had surgery.
Risks of adhesions
Adhesions may:
- develop after any kind of pelvic or abdominal surgery – people who have major or multiple procedures are even more at risk
- cause significantly higher post-operative complications (leaks, wound infections, haemorrhages) in people with adhesion-related perforations. This may also lead to a longer stay in hospital
- lead to other risks and complications, including small bowel obstructions, infertility and chronic pelvic pain
- cause increased risk, complexity and complications during subsequent surgery.
The incidence of adhesions has increased with the rise in gynaecological procedures. Up to 90 per cent of women suffer post-operative adhesions following major gynaecological surgery.
Development of adhesions
Adhesions develop as the body attempts to repair itself. This is the body’s normal response after:
- surgery, particularly abdominal surgery
- infection
- endometriosis
- injury (trauma)
- radiation treatment.
Adhesions can also form after inflammation in the abdomen or pelvis.
Symptoms of adhesions
Although most adhesions are painless and do not cause complications, adhesions cause 60 to 70 per cent of small bowel obstructions in adults and are believed to contribute to the development of chronic pelvic pain.
Adhesion-related disorder (ARD) is a group of symptoms that may occur as a result of adhesions. A person with ARD will usually experience chronic abdominal pain.
Typical adhesions form within the first few days after surgery, but symptoms can last for months or even years. Symptoms may be mostly in one area of the abdomen, but are often generalised, vague, ‘crampy’ and difficult to define. This means ARD can be difficult to diagnose.
Symptoms of ARD may include:
- chronic pain
- infertility
- bowel obstruction and an inability to pass gas
- urinary bladder dysfunction
- pain and difficulty having a bowel movement
- pain on movement such as walking, sitting or lying in certain positions
- emotional disorders such as depression, thoughts of suicide or hopelessness.
Other intestinal problems may include constipation, obstruction, or alternating constipation with diarrhoea from partial obstruction.
Women may experience gynaecological problems, which can add to the anxiety and self-esteem problems that may already be experienced by women who suffer with this disorder.
Symptoms of ARD can be mistaken as a sign of another condition. These can include a whole host of other possible diagnoses such as chronic fatigue syndrome, endometriosis, irritable bowel syndrome, fibromyalgia, depression and anxiety.
Diagnosis of adhesions
It is very difficult to diagnose the chronic pain of adhesions correctly. Diagnostic tests such as blood tests, x-ray procedures, CT scans, MRIs and ultrasound will not diagnose adhesions. Hysterosalpingography (an x-ray that views the inside of the uterus and fallopian tubes) may help diagnose adhesions inside the uterus or fallopian tubes.
According to your symptoms, your doctor will order the appropriate diagnostic tests to rule out other medical conditions that may have similar symptoms.
If the results of these tests are normal or negative for abnormal pathology, a diagnostic laparoscopy may be appropriate. This is the only test that can confirm the presence of adhesions. If adhesions are found, you doctor can usually release them during the same surgery.
Treatment of adhesions
Adhesions can be treated either with open or laparoscopic (keyhole) surgery, known as adhesiolysis. The adhesions are cut by scalpel or electrical current.
Open adhesiolysis
As adhesions are likely to form after certain surgical procedures, open adhesiolysis may not be worthwhile, except to remedy serious problems such as bowel obstruction.
In around 70 per cent of cases, the operation to remove the original adhesions will cause more adhesions to develop. Discuss the risks, benefits and alternatives to surgery thoroughly with your doctor before you make a decision.
Laparoscopic adhesiolysis
People with symptoms of adhesions may consider laparoscopic surgery. The advantage of this procedure is that only a small incision (cut) is required, which is why it is also known as ‘keyhole surgery’. Laparoscopy is the preferred method for performing infertility surgery as there is a decreased risk of new adhesions forming.
Laparoscopic adhesiolysis can significantly improve quality of life among women with chronic pelvic pain due to adhesions. This procedure shows similar results to more invasive forms of surgery when it comes to managing extensive adhesions. However, it can be time-consuming (the procedure may take two to four hours), technically difficult and involves some risk. Adhesion barriers (commercially made) that are placed at the time of surgery may reduce adhesion formations.
Adjuvant treatment (using commercially available product such as intercoat) after adhesiolysis is beneficial in preventing the development of intrauterine adhesions.
Most women who choose to have laparoscopic adhesiolysis:
- are discharged on the same day of the procedure
- don’t need to have major abdominal cuts (incisions)
- experience minimal complications
- return to full activity within one week of the procedure.
Non-surgical treatments for adhesions
Alternatives to surgery include:
- medication – this is often the first treatment choice for acute pain and forms part of the treatment for chronic pain
- exercise
- physical therapy
- lifestyle changes
- soft tissue mobilisation (Wasserman et al 2019)
Although they can be helpful, medications are not a cure-all. They can cause side effects or may be ineffective, and are often costly. A pain specialist can advise you on the non-surgical treatment options most suited to your situation.
Where to get help
- Your GP (doctor)
- Nurse-on-Call Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)
Clear Passage Physical Therapy | Gainesville, FL
A Non-Surgical, Drug-Free Treatment
Studies Published in Major Medical Journals
Hands-On Care With Proven Results
The Clear Passage®️ Approach is a revolutionary hands-on technique designed to break up adhesions, scar tissue and other blockages that prevent the muscles, organs and systems of your body from working properly. Our technique is a natural, non-surgical, drug-free solution that treats the core problem, not just the symptoms.
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Our Mission Statement
Clear Passage®️ strives to provide our patients with the finest hands-on therapy in the world. We team with each patient and focus 100% of our effort on each patient’s goals, in a professional but compassionate environment. We are dedicated to obtaining positive results for each patient and to publishing meaningful research that accurately documents our results. We feel that our team of therapists, researchers, advisors and support staff must practice excellence, kindness and a deep understanding in order to deliver superior care to patients.
Welcome to our practice
Hands-On Care With Proven Results
WHAT WE TREAT
Clear Passage®️ specializes in the treatment of adhesions – internal scars that can cause various types of pain and dysfunction in patients. Adhesions are bands of internal scar tissue that the body forms in response to inflammation, infection, surgery, trauma, or radiation therapy.
WHO WE ARE
Over the years, the Clear Passage®️ team has developed, tested and published results on protocols that are effective in treating a wide variety of adhesion-related conditions including female infertility, women’s health, hormonal conditions, chronic and post-surgical pain, and bowel obstructions.
OUR RESULTS
Clear Passage® measures results scientifically. We provide statistical analyses of our results, publish scientific studies in peer-reviewed journals, and conduct clinical trials to evaluate the safety and effectiveness of our treatments. To learn more, please click the button below.
What We Treat
What We Treat
Clear Passage®️ specializes in the treatment of adhesions – internal scars that can cause various types of pain and dysfunction in patients. Adhesions are bands of internal scar tissue that the body forms in response to inflammation, infection, surgery, trauma, or radiation therapy.
Learn More
Who We Are
Who We Are
Over the years, the Clear Passage®️ team has developed, tested and published results on protocols that are effective in treating a wide variety of adhesion-related conditions including female infertility, women’s health, hormonal conditions, chronic and post-surgical pain, and bowel obstructions.
Learn More
OUR RESULTS
OUR RESULTS
Clear Passage® measures results scientifically. We provide statistical analyses of our results, publish scientific studies in peer-reviewed journals, and conduct clinical trials to evaluate the safety and effectiveness of our treatments. To learn more, please click the button below.
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A Personalized Approach to Patient Care
Our Treatment Philosophy
From your first visit, we examine your body and work to understand your goals. We then perform a highly specialized manual ‘hands-on’ therapy to treat the causes of your pain or dysfunction. We feel it is important to address the body as a whole, rather than in parts.
Because we see each patient as an expert in her/his body and its history, we invite each patient to become an active member of the team that is evaluating and treating them. Thus, we establish a two-way communication protocol with each patient to ensure their comfort level and full understanding of our intent and findings at all times.
A Streamlined Approach To Patient Care
Our Treatment Philosophy
From your first visit, we perform specialized manual ‘hands-on’ therapy to treat the causes of your pain or dysfunction. We feel it is important to address the body as a whole, rather than in parts.
Because we see each patient as an expert in her/his body and its history, we invite each patient to become an active member of the team that is evaluating and treating them. Thus, we establish a two-way communication protocol with our patient to ensure their comfort level and full understanding of our intent and findings.
Professionalism
Our integrity is inherent in all aspects of our conduct as we treat each patient in a responsible, honest and confidential manner.
Research
We are committed to developing meaningful scientific data that examines our methods and results and to increasing quality, knowledge and innovation in non-surgical healthcare, through scientific, educational and academic endeavors.
Compassion
Our relationships with patients and their families are based on a depth of interest and understanding that is rarely seen in healthcare today. When we treat, the patient’s goals are our sole focus.
Dedication
Our number-one goal is success for each patient. Achieving this goal requires understanding each patient’s goals and providing focused, professional attention to every patient at all times.
Accredited & Experienced Professionals
What Sets Our Practice Apart?
Professionalism
Patients deserve to be treated with dignity, kindness and respect, their voices heard and their feelings acknowledged.
INTEGRITY
Integrity is inherent in all aspects of our conduct. We believe that hearing and knowing the truth are basic patient rights.
UNRUSHED HEALING
Most pain and dysfunction occurs over time. One to three-hour sessions allow us time to reverse longstanding problems.
Research
We are committed to meaningful scientific enquiry to examine the safety and measure the effectiveness of our therapy.
COMPASSION
Our relationships with patients and their families reflect a deep interest and understanding rarely seen in healthcare.
Dedication
Our primary goal is success for each patient. From the time we enter your room, our sole focus is achieving your goals.
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A Natural, Non-Surgical, Drug-Free Solution
Conditions We Treat Caused by Scar Tissue and Adhesions:
Women’s Health
Post-Surgical Pain
Infertility
Chronic Pain
Abdominal Problems
Women’s Health
Post-Surgical Pain
Infertility
Chronic Pain
Abdominal Problems
A Natural, Non-Surgical, Drug-Free Solution
Conditions We Treat Caused by Scar Tissue and Adhesions:
Pregnancy Rate for
Blocked Fallopian Tubes
Prevented Surgery for
Bowel Obstruction
Increased Quality of Life
for Endometriosis
65-96%
Reduced
Chronic Pain
Women’s Health
Menstrual Pain
Lubrication & Orgasm
Intercourse Pain
Genital Mutilation
Endometriosis Pain
Cervical Stenosis
Chronic Pain
TMD/TMJ
Tailbone (Coccyx) Pain
Post-Radiation Pain
Neck Pain
Myofascial Pain
Migraines/Chronic Headaches
Early Surgery & Trauma
Back & Hip Pain
Abuse
Post-Surgical Pain
Myomectomy Pain
Mastectomy Pain
Hysterectomy Pain
C-section Pain
Abdominal Problems
Ulcerative Colitis
Small Intestinal Bacterial Overgrowth (SIBO)
Chron’s Disease
Bowel Obstructions
Adhesions
Abdominal P
Infertility
Unexplained Infertility
Secondary Infertility
PRE-IVF Treatment
Polycystic Ovarian Syndrome
Hydrosalpinx
FSH, Hormonal Problems
Endometrosis & Infertility
Blocked Fallopian Tubes
Opening Blocked
Fallopian Tubes
Decreased
Menstrual Pain (Endo)
15 Times
Less Total Bowel Obstructions
Pregnant with
Endometriosis
56% – 64%
Increased, First
Ever Orgasms
44% – 54%
Age 41+ IVF Pregnancies
2½ Times
Less Partial
Bowel Obstructions
45% – 50%
Hydrosalpinx Cleared
PCOS – Pregnancies
71% – 78%
Increased Libido
74% – 86%
Increased
Sexual Arousal
High FSH – Pregnancies
70% – 79%
Increased Lubrication
Decreased
Ovulation Pain (Endo)
Three Times
Fewer Bowel Surgeries
An Evidence-Based Approach
Published Success Rates
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Opening Blocked
Fallopian Tubes
Decreased
Menstrual Pain (Endo)
Less
Total Bowel Obstructions
93% – 96%
Decreased
Intercourse Pain
Fewer Surgeries for Bowel Obstructions
Pregnant
After
Opening Tubes
Pregnant with
Endometriosis
56% – 64%
Increased, First
Ever Orgasms
44% – 54%
Age 41+ IVF Pregnancies
Less Partial
Bowel Obstructions
45% – 50%
Hydrosalpinx Cleared
PCOS – Pregnancies
71% – 78%
Increased Libido
74% – 86%
Increased
Sexual Arousal
High FSH – Pregnancies
70% – 79%
Increased Lubrication
Decreased
Ovulation Pain (Endo)
Convenient Locations In The United States & United Kingdom
Treating Chronic Pain, Obstructions and Infertility Naturally
Patient Information
We look forward to helping you achieve a life free of pain and dysfunction. If you haven’t already done so, please complete our online Request Consultation form.
Meet The Clear Passage®️ Therapists
Endorsed by Doctors and Patients Around the World
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Our Testimonials
The love story of Belinda and Larry Wurn, and the birth of the Wurn Technique reveals that when we approach the body with reverence, intelligence and a desire to reduce suffering, we can repair what the most sophisticated technologies fail to fix.
Julia IndichovaDirector, Fertile Heart Studio, Author of ” Inconceivable” and “The Fertile Female”
I don’t know which is more amazing: the adventure of discovering the treatment, the published medical studies, or the dozens of Miracle Moms who shared their stories of success with this 100% natural therapy.
Gilli MoorhawkAuthor of “Miracle Babies,” and “Meditations and Positive Thoughts for Pregnancy & Birth”
Clear Passage Therapy is remarkable. It is the only therapy empirically shown to improve all four phases of female sexual function — arousal, lubrication, orgasm, and satisfaction, as well as the current gremlins, “low desire” and “pain on intercourse”.
Dr. John D. Perry, Ph. D.Psychologist, Author of “The G Spot”
As a Fertility and IVF specialist, I am always looking for new options to improve success. Any therapy that helps restore natural pelvic organ function will help increase and preserve fertility. The “Wurn Technique” seems to do just that. I have seen patients benefit.
Dr. Mark Kan,Ob/GynIVF and Reproductive Medicine Physician, Newport Beach, CA
Adhesions are a major problem for women with endometriosis, causing pain which can continue for decades, sexual and bowel function problems, and other movement. Previously, only surgery was available, which in itself could lead to more adhesions.
Dr. Mary Lou Ballweg, Ph.D.Co-founder, President, Executive Director, Endometriosis
I really believe that my treatment sessions improved my hormonal function. Prior to my treatment, ovulation was a one-day burst. After treatment, I had a gradual rise in estrogen which is consistent with healthy hormonal balance.
AlexisDecember 13, 2020
What a much-needed, useful and safe way to deal with the common, yet mystifying problem of adhesions. You have perfected a technique to treat adhesions, with years of experience, scientific ‘backup’ and case studies to prove it.
Dr. Leslie Mendoza TempleMedical Director, Integrative Medicine
Faculty: Northwestern University Medical School
The journey has been an incredible, eye-opening experience. From the moment I met my therapists and completed the comprehensive initial evaluation, I felt like a team of experts was intensely focusing on fixing my body of pain and adhesions.
RebeccaApril 04, 2018
I attended treatment and found that my pain reduced markedly. I stopped experiencing pain in my bowels, neck, and back. Things in life that most people take for granted, but that had been denied to me for so long, slowly began to return.
GinnyMarch 07, 2019
Session after session, day after day, my body was slowly and methodically worked on. As each hour passed, my body was loosening up and moving with less effort and pain. I truly feel like I had a full body renovation with my treatment at Clear Passage®️.
ReeseJanuary 06, 2021
From every aspect, Clear Passage®️ fulfills it’s mission of care, compassion and successful treatment beyond any of my hopes. Without exception, the wonderful people who staff this beautiful relaxed environment encourage trust and confidence.
LeaOctober 06, 2020
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National Headquarters: 4421 NW 39th Ave, Suite 2-2 Gainesville, FL 32606
License: MA11614
At Clear Passage®️, you get more than a physical therapist — you get a partner in your health. We have clinics throughout North America and the United Kingdom. Patients travel from all over the world to receive treatment at our various locations.
In all cases, we review your specific goals, process all paperwork, and scrutinously review your medical history through our Gainesville Headquarters. This helps ensure that the Clear Passage®️ Approach has the best chance to be safe and effective for you. Once we feel confident about that, we are glad to help you choose the therapist(s) and location that will serve you best.
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Removal of synechia in the nose, surgery to remove adhesions in the nose in the clinic of Dr. Korenchenko
Synechia (adhesions) in the nose are adhesions in the sinuses. It can grow together as a connective tissue that lines the sinuses from the outside, as well as cartilage and even bones.
Connective tissue can grow together due to nasal injuries, especially if the patient has not consulted a doctor to eliminate their consequences in a timely manner. Removal of nasal adhesions may be required after surgery in the nose and other surgical interventions on the sinuses – excision of polyps, removal of neoplasms and others.
The fusion of cartilage and bone tissue is also congenital. This is due to pathologies of fetal development associated with intrauterine infection or the influence of other teratogenic factors. Most often, the formation of the bones of the skull is disturbed due to syphilis, which is transmitted from mother to fetus.
How to suspect the presence of synechia (adhesions) in the nose?
Since adhesions are almost impossible to see with the naked eye without an endoscopic examination, most often patients come to a doctor’s consultation with complaints of a variety of symptoms, the appearance of which is due to the presence of synechia:
- Sinusitis of various localization.
- Inflammation of the upper respiratory tract – laryngitis, tracheitis, pharyngitis.
- Inflammation of the lower respiratory tract – bronchitis and pneumonia.
- Inflammation of the ear – otitis media and eustachitis.
The dissection of synechia in the nose in these cases is necessary, as they reduce the lumen of the nasal passage, which makes it difficult for normal air circulation. Over time, it becomes increasingly difficult for the patient to breathe through the nose and mouth breathing comes to the fore. In this case, when it enters the body, the air is not warmed up, not humidified and not cleaned of microimpurities and small particles. Getting on the mucous membranes of the ENT organs, it causes inflammation of the latter.
Treatment of nasal synechia – is there an alternative to surgery?
Unfortunately, the removal of synechia of the nose is carried out only surgically. There is no other way to get rid of them.
How is the operation to remove synechiae performed?
See also
Treatment of ENT diseases
Removal of nasal synechia
Excision of the synechia of the nasal cavity is carried out under local anesthesia. The most common method is the classic removal of connective tissue growths with a scalpel or laser.
The operation is carried out under the control of an endoscope, so the doctor sees everything that happens on the monitor, which significantly increases the accuracy of manipulations. To prevent further tissue growth and the formation of new synechiae and scars, special tampons or other devices are introduced into the nasal cavity, which remain there until the mucosa is completely healed.
If the synechiae were located in the anterior part of the nasal passages, then an operation can be performed to remove them with a laser. This method is more successful, because due to the low tissue trauma, the percentage of relapses is significantly reduced. The operation is performed under local anesthesia and is characterized by a short rehabilitation period.
In our clinic, the operation to remove synechia lasts from 10 to 20 minutes and is performed on an outpatient basis under local anesthesia. The intervention is exclusively intranasal, after it there are no external manifestations in the form of hematomas (bruises) on the face. The next day, the patient needs to visit the clinic for a postoperative examination. After this operation, the patient immediately returns to normal life.
The following restrictions are recommended after surgery
reduce active physical activity for 1 week
for 2 weeks a ban on visiting the pool, baths, saunas
if a flight is planned, then it is possible 7 days after the operation
Treatment of hydronephrosis in children – hydronephrosis of the kidney in a child Article EMC
Narrated by Zukhra Sabirzyanova,
pediatric urologist-andrologist, Ph. D.
In children with hydronephrosis, the ureter is not properly formed. This is a congenital condition that can manifest itself at different stages of fetal development, starting from the first trimester.
Types of hydronephrosis in children
Hydronephrosis may be non-obstructive and does not require surgical treatment.
Corrected hydronephrosis is also common. This is when, after plastic surgery of the ureteropelvic segment, the kidney still does not contract, the dilated calyces remain wide enough, but the urine outflow is restored. Often this happens when a kidney with very poor function is operated on. The main thing we are fighting for is not the narrowing of the pelvis, but the restoration of outflow from the kidney. In such cases, it is sometimes necessary to perform a second operation when the child grows up.
There is an international classification according to degrees of hydronephrosis – SFU (Society of fetal urology, International Society of Prenatal Urology). According to this classification, there are 5 degrees of hydronephrosis (from 0 to 4). Hydronephrosis grades 2 and 3 according to SFU in most children resolve spontaneously in the first year of life in the process of growth. This happens because the baby is predominantly lying down, he has a weak and undeveloped muscle of the pelvis. As the child grows, the urinary tract begins to mature. The smooth muscles of the intestine mature, the skeleton and muscles mature, the same thing happens with the smooth muscles of the upper urinary tract. In an upright position, the urinary tract is much easier to work with. That is why hydronephrosis in young children is recommended to be observed during the first year (if the kidney function is preserved, if there is no inflammatory process, if it is a unilateral process).
Causes of hydronephrosis in children
The cause of hydronephrosis can be an intrauterine defect: stricture, stenosis of the ureteropelvic segment, accessory vessel, high ureteral outlet, stone, tumor, external adhesion.
Symptoms
If hydronephrosis is not diagnosed in utero, it may not appear for a long time (if hydronephrotic transformation is not associated with acute renal obstruction). That is why, as part of the medical examination of children of the first year of life, ultrasound of the abdominal organs, including the organs of the urinary system, is necessarily performed. This is a screening ultrasound that will allow you to suspect a malformation of the urinary system and identify it before the addition of complications, for example, an acute inflammatory process due to a violation of the outflow of urine from the kidney.
If it is a hydronephrotic transformation without impaired renal function, it is almost impossible to suspect it. Therefore, we encourage parents not to neglect the medical examination of their children and to carry it out in full. Those. urinalysis and ultrasound examinations were performed.
Diagnostic methods
Given the possibilities of prenatal diagnosis, fetal ultrasound often makes it possible to establish a diagnosis even before birth.
However, doctors do not always detect this pathology in the fetus during ultrasound examinations during routine screenings at 20-22 and 31-33 weeks of pregnancy. But if a violation is detected, then they call it, as a rule, not hydronephrosis, but intrauterine pyeloectasia – an expansion of the pelvis.
Quite often we come across the fact that specialists in intrauterine diagnostics, seeing a one-sided process, a slight expansion of the pelvis, tell mothers that the child will be born, “registered”, and everything will pass. Perhaps this is correct in terms of keeping the pregnant woman calm. But any mother who was informed during pregnancy about the abnormal formation of the kidney and urinary tract of the fetus should understand that on the 5th – 7th day after the birth of the baby, it is necessary to conduct an ultrasound screening . It is on the 5-7th day, and not earlier, because in the first days after childbirth, a sufficient amount of fluid does not pass through the child’s ureter, the kidneys secrete little urine and ultrasound diagnostics will not be so informative. It is on the 5th – 7th day after birth that the child develops diuresis. Therefore, if we are not talking about the critical condition of the child, a bilateral process or poor indicators of a biochemical blood test, it is advisable to carry out ultrasound screening on the 5-7th day of the child’s life.
Ultrasound is a screening method that allows you to suspect a developmental anomaly (malformed kidney, dilated pelvis, dilated calyces, etc.). But to establish the diagnosis of hydronephrosis, this study is not enough.
The most important thing in the diagnosis of hydronephrotic transformation is to determine the functional state of the kidney and upper urinary tract. That is, the preservation of kidney function (secretory, responsible for the formation and accumulation of urine and excretory) and urodynamics of the upper urinary tract (an indicator of how quickly urine enters the bladder through the upper urinary tract) are important. Excretory urography , accepted in our country in most clinics, even performed on the most modern digital equipment, according to its methodology, will not allow diagnosing hydronephrosis, this study gives an idea only of the anatomical state of the kidney.
Dynamic scintigraphy is the only method that allows you to evaluate the picture of the disease, to understand whether the disease is obstructive and whether it requires surgical correction. In some cases, in addition to ultrasound and dynamic scintigraphy, we perform computed tomography (CT) to determine the cause of hydronephrosis, anatomy of the kidney and planning surgical intervention.
Treatment of hydronephrosis in children
There is no drug therapy for hydronephrosis. But it is important to prevent inflammatory complications. If an infection joins the expanded pelvis, the outflow of urine from it will be disturbed, an inflammatory process may form – pyelonephritis.
After the diagnosis is established, when the doctor saw that the hydronephrosis is obstructive, that the outflow of urine from the kidney is really impaired, he proceeds to formulate a treatment plan. Surgical treatment is aimed at eliminating the narrowing zone in the ureter and performing plastic surgery between it and the pelvis. There are different types of interventions:
- classical operation through the “incision” (lumbotomy),
- laparoscopic (operation through “punctures” in the abdominal wall),
- retroperitoneoscopic surgery,
- robot-assisted plasty.
We do not operate on the pelvis of the ureter, but on the child. Therefore, the method of surgical treatment is selected individually. A good urologist-surgeon should be proficient in all the techniques of performing operations, and the clinic should have all the necessary equipment and instruments.
Of course, laparoscopic techniques have a number of advantages over open surgeries: more accurate results, shorter recovery period, no scars, lower risks of postoperative complications. The robotic console allows surgeons to create an anastomosis with pinpoint precision and minimal tissue trauma. The width of the anastomosis in a child is 1.5 – 2 cm, and about 15 – 20 sutures are applied to this area.
However, robot-assisted technology may not be suitable for a particular child. It all depends on age, general somatic condition, anthropometric indicators, which may not allow the installation of a robotic console. When planning a laparoscopic intervention, it is important whether adequate anesthesia can be performed, because this too has its own characteristics.
Thus, the type of operation is determined not by an individual surgeon, but by a team that includes an anesthesiologist, a pediatrician, a surgeon from the standpoint of what will be most effective and safe for a particular child.
But don’t be afraid of scars. The question is not the size of the incision, but the fact that surgical treatment is performed as efficiently and safely as possible for a particular patient.
Features of the treatment of bilateral hydronephrosis
Bilateral process is a more serious situation. Already from the discharge from the maternity hospital, such children are taken under the supervision of pediatric urologists and they plan to conduct an operative intervention. Rarely, operations are performed on both sides at once. Sometimes drainage is placed on one side, and plastic is made on the other. But this is very individual.
Prognosis and possible complications
If we talk about classic unilateral hydronephrosis with preserved kidney function, the prognosis is very good, and most of our patients have no restrictions by adolescence.
If hydronephrosis is left untreated, the kidney will lose its function and will have to be removed.
Recovery after surgery
Within 3-7 days after any reconstructive plastic intervention, the patient has drains, a nephrostomy, a stent. At this time, the patient is observed by a urologist in a full-time hospital, or a day hospital, depending on the patient’s condition.
When a child does not require fluid therapy, pain relief and continuous monitoring, we discharge him from the hospital. Of course, we remain in touch with our patients and are ready to advise and assist around the clock.
After the use of robotic technology in a child, the recovery period is only 3 days instead of 6-7 days after laparoscopic surgery.
In the future, the child must undergo regular examinations to assess how the created anastomosis works, the kidney, how the ureter grows, etc. We observe children up to 18-20 years of age to be sure that the operated organ has time to grow with the child.
Nutrition
There are no restrictions on nutrition. But we recommend that you follow the drinking regime for the formation of the correct function of the kidney.
Physical activity
If the child is involved in sports, restrictions on physical activity after surgery should be observed for about 1 month. If a small child was operated on, then there is no question of restrictions. On the second day after the operation, babies walk, run, jump and behave as usual.
Advantages of treatment at EMC
- EMC is the only clinic in Russia where urological surgeons perform robotic operations for upper urinary tract defects in children, i.