Clinical Course of Prenatally Diagnosed Ureteropelvic Junction Obstruction

Oh, Chang Jun; Seo, Young Jin; Chung, Sung Kwang

Abstract

PURPOSE: Recently there has been a change in the management concept of ureteropelvic junction obstructions (UPJO) diagnosed prenatally. We retrospectively analyzed our experience in treating neonates, with prenatally detected UPJO, to find a desirable therapy.
MATERIALS AND METHODS
52 neonates (64 kidneys), with prenatally diagnosed UPJO, between 1994 and 2001, were included in this study for evaluation. The patients consisted of 41 males and 11 females. The UPJO was found unilaterally in 40 and bilaterally in 12 of the cases. With all the whole cases, ultrasonography, diuretic renogram and voiding cystourethrography were performed to assess the renal function. Additionally, a 99mTc-DTPA renal scan and monitoring of the glomerular filtration ratio (GFR), were performed in the bilateral UPJO. During the follow up period, including monthly urinalysis, ultrasonography and a 99mTc-DMSA renal scan were performed every 3 to 6 months. Antibiotics were given as a preventive measure.
RESULTS
Of the 40 kidneys, a differential renal function above 40% accounted for 36, between 5-40% for 2, and below 5% for 2 of the unilateral UPJO. With the bilateral UPJO, all the cases represented preserved renal function (>40%) and normal GFR. With the unilateral UPJO, pyeloplasty was performed on 23 kidneys (57.5%), and a nephrectomy was performed in 2 (5%). With of the 15 kidneys (37.5%) the obstructions disappeared during the observation period. With the bilateral UPJO, pyeloplasty was performed in 4 kidneys (16.7%), and in 20 (83.3%) the obstructions disappeared during the observation period. Conservative treatment was performed when the differential renal function was above 5%, with no deterioration in the renal function, no febrile urinary tract infection (UTI) and no increase of hydronephrosis. Pyeloplasty was performed on the patients with a recurrence of febrile UTI (19 kidneys), severe hydronephrosis (4) and gradual decrease in renal function (4), during the follow-up period.
CONCLUSIONS
With the UPJOs diagnosed prenatally in neonates it seems desirable to wait for the natural disappearance of the obstruction, with conservative treatment, if the renal function is preserved. In cases where there is a progressive loss of renal function, or a secondary effect of the obstruction, pyeloplasty should be considered.