Ureteropelvic Junction Obstruction in Children : Diagnosis and Management

Lee, Eun Sik; Lee, An Kie; Lee, Chong Koo; Choi, Hwang

Abstract

We reviewed the clinical courses and surgical results of 32 children with ureteropelvic junction obstruction since June, 1985. Major presenting features were abdominal mass and urinary infection in children less then 3 years old and pain was the most frequent presenting symptom in older children. Five children had bilateral involvement. Thirty two pyeloplasties and four nephrectomies were done in 36 renal units. Preoperatively six children had been managed with percutanous nephrostomy due to pyonephrosis, azotemia and marginal renal function. Radiographic and/or functional improvement were recognized in 30 kidneys(94%) In solitary kidney, bilateral involvement, severe infection and redo case, stent and/or nephrostomy applied. Neither stent nor nephrostomy was used in 25 operations and the results were satisfactory in all. Urinary infection might have affected the surgical results inspite of preoperative control. Postoperatively transient urinary leakage developed in 4 children and bacteriuria in 11 but disappeared soon. Excretory urography was performed in all and was enough to diagnose in most patients but in recent period we evaluated the ultrasound study and radioisotope renal scan. We feel these methods are satisfactory in the diagnosis and follow-up of UPJ obstruction and IVP is not always mandatory.