A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function

Arena, Salvatore; Chimenz, Roberto; Antonelli, Elisabetta; Peri, Flora Maria; Romeo, Paola; Impellizzeri, Pietro; Romeo, Carmelo

doi:10.1007/s00431-018-3239-2

Cited by 31 publications

(22 citation statements)

References 37 publications

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“…First, that rates of resolution and/or improvement even for severe dilation, as in grade 3 and 4 as defined by the Society for Fetal Urology (SFU) are reasonably good. Indeed, complete resolution rates in observed children range from 33 to 70% (16)(17)(18)(19)(20)(21)(22)(23). In the literature, lower rates of resolution are associated with more severe hydronephrosis.…”

Section: Natural History Of Prenatally Detected Hydronephrosismentioning

confidence: 99%

Managing Ureteropelvic Junction Obstruction in the Young Infant

Passoni

Peters

2020

Front. Pediatr.

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In the last decade, management of congenital UPJ obstruction has become progressively observational despite the lack of precise predictors of outcome. While it is clear that many children will have resolution of their hydronephrosis and healthy kidneys, it is equally clear that there are those in whom renal functional development is at risk. Surgical intervention for the young infant, under 6 months, has become relatively infrequent, yet can be necessary and poses unique challenges. This review will address the clinical evaluation of UPJO in the very young infant and approaches to determining in whom surgical intervention may be preferable, as well as surgical considerations for the small infant. There are some clinical scenarios where the need for intervention is readily apparent, such as the solitary kidney or in child with infection. In others, a careful evaluation and discussion with the family must be undertaken to identify the most appropriate course of care. Further, while minimally invasive pyeloplasty has become commonly performed, it is often withheld from those under 6 months. This review will discuss the key elements of that practice and offer a perspective of where minimally invasive pyeloplasty is of value in the small infant. The modern pediatric urologist must be aware of the various possible clinical situations that may be present with UPJO and feel comfortable in their decision-making and surgical care. Simply delaying an intervention until a child is bigger may not always be the best approach.

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Section: Natural History Of Prenatally Detected Hydronephrosismentioning

confidence: 99%

Managing Ureteropelvic Junction Obstruction in the Young Infant

Passoni

Peters

2020

Front. Pediatr.

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“…With routine antenatal ultrasonography, urological anomalies are identified as early as 12-14 weeks of gestation [2]. Fetal hydronephrosis, causes postnatal UPJO in 0.2-0.4% of cases [1][2][3] and 15-39% of them require surgical intervention [4][5][6][7][8]. Pyeloplasty is an effective surgical treatment to improve urinary drainage and affects postoperative renal function of the involved renal unit, but not all kidneys improve after surgical treatment [9,10].…”

Section: Introductionmentioning

confidence: 99%

Functional outcome after neonatal pyeloplasty in antenatally diagnosed uretero-pelvic junction obstruction

2021

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Background With routine antenatal ultrasonography, fetal hydronephrosis is commonly diagnosed. This leads to early detection of postnatal uretero-pelvic junction obstruction which may require surgical intervention. But, there is no clear consensus in the benefits of operating these patients in the neonatal age. Methods Aim—To study the functional outcome after pyeloplasty in neonates with antenatally diagnosed unilateral uretero-pelvic junction obstruction (UPJO). Records of all neonates (N = 48) who presented between 2016 and 2018 with prenatal diagnosis of unilateral UPJO and underwent a Anderson-Hyne’s Pyeloplasty were retrospectively analyzed. Indications for surgery were SFU grade 3 or 4, a split renal function (SRF) < 40% on a diuretic renal scan and antero-posterior renal pelvic diameter (APD) > 2.5 cm with parenchymal thinning. Parenchymal thickness (PT) and APD measured by ultrasonography, and SRF measured by 99 m Tc-EC renal scan were compared before and after surgery. Results Our study comprised of 48 patients with 79.2% males (n = 38). UPJO affected the left side more (n = 30, 62.5%). The mean age at pyeloplasty was 28 days (range 26–30). The outcome was considered successful in 46 (95.84%) patients. The APD decreased from a mean of 3.5 cm APD preoperatively to 1.38 cm 1 year later which was statistically significant (p < 0.001). The PT increased from 3.95 to 7.1 mm 1 year postoperatively which was significant (p < 0.001). The drainage pattern and SRF improved in 46 (95.84%) patients. The SRF improved from a mean of 35.48–44.7% 1 year postoperatively which was significant (p < 0.001). Conclusion Pyeloplasty done in the neonatal age for prenatally diagnosed UPJO, having SFU grade 3–4 UPJO, leads to significant improvement of SRF and PT with minimal complications. Neonatal Pyeloplasty for significant UPJO is a safe procedure which provides the kidney maximum opportunity to improve function.

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“…Furthermore, surgery was not required in any of their study patients. Recently, we reported our experience in pediatric p a t i e n t s w i t h n e o n a t a l l y d i a g n o s e d u n i l a t e r a l hydronephrosis due to ureteropelvic junction obstruction with poor drainage but good differential renal function at renal scan [1]. According to our experience, all patients with a RPAPD ≤ 15 mm did not require any surgical procedure and were safety conservatively managed even if they had a poor drainage at first renal scan.…”

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confidence: 99%