The Case for Immediate Pyeloplasty in the Neonate with Ureteropelvic Junction Obstruction

Abstract

The 99mtechnetium-diethylenetriaminepentaacetic acid renal scan allows differentiation of ureteropelvic junction obstruction from multicystic kidney in most instances. Although renal function usually will improve at least a little after relief of obstruction, the young infant is privileged and more improvement can be expected than occurs usually in older children. Since an operation is as safe and results of pyeloplasty are as good in the neonate as in older infants or children early correction of ureteropelvic junction obstruction is advocated in otherwise healthy infants as soon as the diagnosis is established.

Does delaying pyeloplasty affect renal function in children with a prenatal diagnosis of pelvi‐ureteric junction obstruction?

“…The postnatal treatment of children with prenatally diagnosed hydronephrosis remains controversial in terms of the optimal timing of surgery, the ability to define which kidney will benefit from surgical intervention and which children will have a deterioration in renal function under surveillance [3][4][5][6][7][8][9][10]. The recovery of kidney function after either surgery or conservative management is the main issue in the treatment of patients with PUJ obstruction [6][7][8][9]15,16].…”

“…The recovery of kidney function after either surgery or conservative management is the main issue in the treatment of patients with PUJ obstruction [6][7][8][9]15,16]. Recently there has been a trend away from aggressive surgery to a more conservative approach [14,15].…”

“…Maternal ultrasonography detects fetal hydronephrosis, leading to the diagnosis of PUJ obstruction postnatally in 0.2-0.4% of cases [1][2][3][4][5]; PUJ obstruction requires surgery in 15-30% of affected children [6][7][8][9][10][11][12][13][14]. Controversy continues on the optimal timing of the surgical correction in these children with antenatally detected hydronephrosis [7,8,[14][15][16][17].…”

“…Children with an antenatal diagnosis of PUJ obstruction reportedly show a significant improvement in renal function after surgery compared with those who are diagnosed and operated much later because of their clinical symptoms [12]. In early published series, King et al [6] encouraged immediate pyeloplasty, regardless of renal function, after obstruction was detected by diuretic renography. In recent years, Koff et al [7,9,15] suggested that unilateral antenatal hydronephrosis caused by PUJ obstruction is a relatively benign condition requiring surgery only in highly selected cases.…”

Giant Hydronephrosis Due to Pelviureteric Junction Obstruction

“…This has been proven histologically. [1][2][3] It leads to failure of transmission of peristaltic waves across the PUJ, causing hydronephrosis. It is usually unilateral; however, 10% to 25% of cases are bilateral.…”