The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction
Article first published online: 23 MAY 2003
Volume 91, Issue 9, pages 850 –852 , June 2003
How to Cite
Thorup, J., Jokela, R., Cortes, D. and Nielsen, O.H. (2003), The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction. BJU International, 91: 850 –852 . doi: 10.1046/j.1464-410X.2003.04228.x
- Issue published online: 23 MAY 2003
- Article first published online: 23 MAY 2003
- Accepted for publication 6 February 2003
- pelvi-ureteric junction
To determine how to select patients for surgery among those with antenatally detected pelvi-ureteric junction (PUJ) obstruction.
PATIENTS AND METHODS
The study comprised 100 consecutive children with antenatally detected suspected unilateral PUJ obstruction and a normal contralateral kidney. The correct diagnosis was made using postnatal ultrasonography, intravenous urography and renal scintigraphy, the last also being used for the follow-up.
Four patients had poor function in the hydronephrotic kidney, treated in three by nephrectomy; 61 had normal function in the hydronephrotic kidney, with 49 followed for 1–10 years with no change in kidney function and no symptoms. Twelve patients in this group had later surgery (at 0.7–8 years old) because of pyelonephritis (four), pain and/or renal functional impairment (eight, three of whom had normal function afterward). Thirty-five patients had moderately impaired function of the hydronephrotic kidney; 29 had primary surgery at a median age of 4 months. The median hydronephrotic renal function increased from 32% before to 42% after surgery, with 15 kidneys having normal function. In one other patient the kidney was lost before surgery. Five other patients were initially treated conservatively and the hydronephrotic renal function increased from 32% to 35% at the 1-year follow-up, significantly less than in the surgical group. The overall operative complication rate was 4%.
With our management programme more than half the patients can avoid surgery in childhood. Although the follow-up was intense there was moderate and irreversible functional kidney deterioration in 5%. In contrast, after successful reconstructive surgery, only a few follow-up procedures causing possible discomfort to the child are needed in most. The risk of surgical complications cannot be neglected. The present results are useful for advising parents deciding whether their antenatally detected hydronephrotic child should undergo surgery or not.