Pelvic Hydronephrosis in Children: A Review of 219 Personal Cases

Abstract

A series of 238 hydronephrotic kidneys in 219 children is reported. The condition was more common in the male than in the female subject and occurred more frequently on the left side. It was often bilateral, especially in infants, with an abdominal mass as the common presenting feature. Loin or abdominal pain was the most frequent complaint in older children. In some cases hydronephrosis presented as a ruptured kidney following trauma. Only 1 patient was hypertensive. The lesion was asymptomatic in 18 cases and the incidence of urinary infection was low. Dismembered pyeloureteroplasty was the procedure of choice for reconstruction. Preliminary nephrostomy was used rarely and nephrectomy was done in 10 per cent of the kidneys. Of the 7 reoperations 4 were for persistent obstruction and 3 were because stones had formed after the pyeloplasty. The late results, assessed clinically and radiologically, have been entirely satisfactory. Many kidneys of initially doubtful value showed useful improvement after reconstructive operation and no secondary nephrectomies were performed. The only death in the series occurred 2 1/2 years postoperatively and was unrelated to the urinary tract.

Spectrum of Lesions Affecting the Renal Pelvis and Pelviureteric Junction: A 13-Year Retrospective Analysis

“…Left sided involvement with male predilection and intrinsic narrowing of the upper ureter secondary to fibromuscular hypertrophy was the commonest aetiology for PUJ obstruction in the present study. As in the case of Johnston et al, in present study too, the commonest presenting feature was abdominal mass followed by abdominal pain [7]. Fibroepithelial polyps are rare benign tumours of the renal pelvis, which can mimic urothelial neoplasms and renal cell carcinomas on radiological imaging and hence, should be evaluated with caution.…”

“…Pelviureteric junction obstruction can present at any age. It is more frequently seen in the left side and boys are more commonly affected [2,6,7]. It is a congenital anomaly caused either due to intrinsic narrowing of the upper ureter or by extrinsic pressure on the ureter caused by aberrant vessels or fibrous bands [8].…”

Bone morphogenetic protein 4 regulates the budding site and elongation of the mouse ureter

“…Thus, in Bmp4 +/-mutants, a wide anatomical spectrum was seen within 1 litter, with each specific anatomical pattern having its counterpart in human (22). As in humans, the murine CAKUT appear predominantly in males (23)(24)(25) CAKUT (26). Finally, mice and humans also share the same renal histological characteristics, namely lack of interstitial fibrosis, with some hypoplastic and cystic dysplastic parenchyma.…”

Accessory or additional renal arteries show no relevant effects on the width of the upper urinary tract: a 64-slice multidetector CT study in 1072 patients with 2132 kidneys

“…Despite numerous examinations that place the frequency of extrinsic UPJ obstruction between 15% and 70% of all obstructions [5,8,[13][14][15][16][22][23][24][25][26], the question as to whether they could actually cause hydronephrosis or are found merely by coincidence in patients with an intrinsic UPJ obstruction remains unanswered [7,12,27]. This was because, for these studies, usually designed retrospectively, only patients with a manifest UPJ obstruction were included and not patients without UPJ obstruction for comparison.…”