Optimal Timing of Surgery in Neonatal Ureteropelvic Junction Obstruction

Kim, Kun Seok; Kim, Hong Sik; Lee, Tae Kyung; Park, Tae Han; Moon, Dae Hyuk; Lee, So Young; Park, Young Seo

Abstract

PURPOSE: There is no agreement in management of ureteropelvic junction obstruction (UPJO) found in neonatal period. We report our clinical results of newborns with UPJO who had been managed with our fixed protocol prospectively.
MATERIALS AND METHODS
According to our protocol, we performed ultrasonography and MAG-3 scan to 45 neonatal UPJO patients at 1, 3, 6 month of age. The patients were divided into three groups, Group I(T1/2>20min, RF<35%), Group II(T1/2>20min, RF>35%) and Group III(T1/2<20min, RF>35%) according to the results of MAG-3 renal scan. The patients received pyeloplasty when belonged to Group I on follow-up renal scan or progression of hydronephrosis on ultrasonography.
RESULTS
At one month of age, 5 patients belonged to Group I, 13 patients to Group II and 27 patients to Group III. In Group I, we performed the operation to all five patients within three month of age. Thirteen patients of Group II showed deterioration of renal function in 3, improvement of renal excretion in 3 and no change in 7 patients within 6 month follow-up respectively. However operations were performed in 10 patients within 6 month of age. The reasons for operation in Group II were as follows: the deteriorated renal function in 3, progressed or severe hydronephrosis in 4, and, urinary tract infection in 3 patients. All 27 patients of Group III showed no deterioration of renal function and no significant obstruction on follow-up studies. Except one patient with recurrent UTI, all of the operated cases have maintained good renal function and nonoperative cases also have shown good renal function until one year old.
CONCLUSIONS
By our management protocol we could choose appropriately the cases which required early intervention or observation without impairment of renal function in neonatal UPJO patients.