Management of Ureteropelvic Junction Obstruction In Infants

Abstract

The frequent use of fetal ultrasound is allowing early (prenatal) diagnosis of numerous uropathies previously delayed until the child either became symptomatic or had a palpable mass. We would anticipate an increasing number of neonates presenting for repair of obstructions, especially ureteropelvic junction obstruction. To evaluate our experience with this disorder in infants we reviewed our experience with ureteropelvic junction obstruction during the last 6 years in 16 infants less than 1 year old. Principles of evaluation, surgical techniques and results are presented. To date, no secondary procedures have been necessary and most neonates have shown dramatic improvement in the parenchymal mass and intrarenal anatomy.

Early Pyeloplasty for Recovery of Parenchymal Thickness in Children with Unilateral Ureteropelvic Junction Obstruction

“…They suggested that potential recovery of renal function is dependent on the timing of surgery. It has been recommended that UPJO be surgically corrected before the age of 1 year, because maturation of renal function is prominent and more rapid during the first 6 months of life [12]. Mayor et al [13], who support early correction, stated that the potential for renal improvement of an affected kidney might change according to life stage.…”

Management of Ureteropelvic Junction Obstruction Using a Microsurgical Technique

“…In the described methods of pyeloplasty the advantages of optical magni fication, adequate instruments and suture material are: greater surgical precision with extramucosal or all-layer [5] watertight sutures, more exact coaptation of the edges of the pyeloureteral anastomosis [2], and minimized tis sue trauma. This has reassured us and other authors [ 10] such that nephrostomy tubes and stents are not neces-H. Oesterwitz, MD Abteilung für experimentelle Organtransplantation Humboldt Universität (Charité) Leninallee 49 DDR-1017 Berlin (GDR)…”

“…Microsurgery has its basis in the observation that, in operations upon small organs or structures, the surgeon's capacity is more limited by this eyes than by his hands [2], Although urologists have been late in recognizing the benefits of microsurgery, today it has a definite clinical application in urological practice and further expansion can be expected in the next few years [3], The use of optical magnification (operating microscope, magnifying loupes), microsurgical instruments and fine polyglactine sutures allows accurate anastomosis in reconstructive surgery of the renal pelvis and the ureter to be accom plished confortably despite tiny structures and sutures [5,10]. Ureteropelvic junction (UPJ) obstruction is a con genital anomaly commonly afflicting the pediatric popu lation, however, it is also seen more frequently than gen erally appreciated in adults [7], The method of postoper ative urinary diversion (to divert by a nephrostomy tube and/or a ureteral stent or not to divert) was a matter of debate until recently [4], Through the application of microsurgery in pyeloplasty, an external urinary diver…”

Endopyelotomy and Pyeloplasty: Face to Face

“…Patient age has been depicted as the single most important factor governing the improvement in function following pyeloplasty [8] apart from the presence or absence of infection. Most workers [9] believe that repair should be made as early as possible preferably before the age of 1 year since maturation of renal function is more rapid in the first 6 months of life and levels off at 2 years. It implies that functional improvement following relief of UPJ obstruction in an adult should neither be expected nor be made a criteria for success.…”