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A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function

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Abstract

The aim of the study was to retrospectively review the outcome of neonatal ureteropelvic junction obstruction with a good renal function and a poor drainage at a first diuretic renal scan, in cases where surgery was recommended on the basis of a loss of renal function, worsening of hydronephrosis or occurrence of clinical symptoms. Hydronephrosis was graded from 1 to 4 or as ureteral tract dilatation (UTD) P1 to UTD P3. During follow-up, 15 out of 38 patients (34.2%) required surgery while 25 out of 38 (65.8%) could have been managed conservatively. In patients with grade 2, 3, and 4 hydronephrosis, the ureteropelvic junction obstruction resolved or improved spontaneously in 100%, 63%, and 33% of cases (in 100% of UTD P1, 67% of UTD P2, and 50% of UTD P3), respectively. The median of follow-up was 14 years. Chi-square test showed a significant relationship between initial grade of hydronephrosis or UTD and the possibility of an efficient conservative management (p = 0.0088 and p = 0.0460).

Conclusion: Conservative management can be safely achieved in ureteropelvic junction obstruction with poor drainage. Scheduled controls are needed for early discovery of functional renal deterioration. High-grade hydronephrosis is unlikely to resolve spontaneously and is often accompanied by a loss of renal function during the first years of life.

What is Known:

• There is controversy about which management should be adopted in infants with unilateral ureteropelvic junction obstruction with poor drainage but good differential renal function.

What is New:

• Long-term follow-up suggests that conservative management can be safely achieved also in unilateral ureteropelvic junction obstruction with poor drainage in more than 60% of cases, even if high-grade hydronephrosis is unlikely to resolve spontaneously and it is often accompanied by a loss of renal function during the first years of life. In our experience, surgical intervention was required in more than 50% of cases before 1 year of life and in all cases before 3 years of life.

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Abbreviations

99mTc-DTPA:

99m-technetium-diethylentriaminopentaacetic acid

APD:

Antero-posterior diameter

DRG:

Diuretic renal scan

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Authors and Affiliations

  1. Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy

    S. Arena, E. Antonelli, F. M. Peri, P. Impellizzeri & C. Romeo

  2. Unit of Pediatric Nephrology, Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, University of Messina, Messina, Italy

    R. Chimenz

  3. Catholic University of Rome, Rome, Italy

    P. Romeo

Authors
  1. S. Arena
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  2. R. Chimenz
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Contributions

Arena Salvatore: conceived and designed, drafted and approved the final version; Chimenz Roberto: critically reviewed the manuscript and approved the final manuscript as submitted; Antonelli Enrica: collected data, drafted the paper; Peri Flora Maria: carried out the analyses of the collected data and approved the final version of the paper; Romeo Paola: drafted the revised manuscript and approved the final version; Impellizzeri Pietro: provided constructive comments to the manuscript; Romeo Carmelo: critically reviewed the manuscript and approved the final manuscript as submitted.

Corresponding author

Correspondence to S. Arena.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Mario Bianchetti

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Arena, S., Chimenz, R., Antonelli, E. et al. A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function. Eur J Pediatr 177, 1761–1765 (2018). https://doi.org/10.1007/s00431-018-3239-2

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  • DOI: https://doi.org/10.1007/s00431-018-3239-2

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