Results of a practical protocol for management of prenatally detected hydronephrosis due to ureteropelvic junction obstruction

Abstract

Pyeloplasty may be performed safely in infants when indicated; however, the majority of children with UPJO can be managed conservatively. Spontaneous resolution of hydronephrosis and/or favorable prognosis was encountered in 87% of conservatively managed RU. The use of a standard US grading system, selective utilization of follow-up renal function testing, and parental compliance are important factors in successful management.

Long-term follow-up and management of prenatally detected, isolated hydronephrosis

“…We observed that the ratio of C/P was significantly improved postoperatively in both groups but greater in the early pyeloplasty group. Different follow-up protocols have been suggested by different authors [7,26]. Some authors have used US as a main diagnostic tool during follow-up.…”

The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis

“…5) [38]. Its incidence in children with ANH varies greatly between studies from 5% to 64% of patients [49,51,52]. The variability corresponds to differences in the management of these children, from early surgery to close observation until renal function deterioration or progression of hydronephrosis occurs.…”

When is it necessary to perform nuclear renogram in patients with a unilateral neonatal hydronephrosis?

“…Postnatal assessment should start on day 3 or 4 of life since US earlier than this can lead to false negative results [2,3]. If no dilatation is detected, a repeat US should be performed within 4-6 weeks to avoid the possibility of a genuine obstructive uropathy that can be masked by transient oliguria.…”