Skip to main content
SpringerLink
Log in

Management of neonatal ureteropelvic junction obstruction

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

No topic in urology is more contentious than the management of neonatal ureteropelvic junction obstruction. Those favoring early diagnosis and correction of obstruction in early infancy cite excellent return of function and superior surgical results compared with delayed repair. Others believe that hydronephrosis improves or resolves with growth in many instances. In the most widely quoted series, almost all such patients improved. This article attempts to separate opinion from fact. The arguments for early surgery and for observation, even when obstruction has been diagnosed, are reviewed. Several experiences with long-term surveillance are summarized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Ransley PG, Risdon RA: Reflux and renal scarring. Br J Radiol 1978, (suppl).

  2. Gordon I, Dhillon HK, Gatanash H, et al.: Antenatal diagnosis of pelvis hydronephrosis: assessment of renal function and drainage as a guide to management. J Nucl Med 1991, 32:1649–1654.

    PubMed  CAS  Google Scholar 

  3. Conway JJ: “Well tempered” diuretic renography: its historical development, physiological and technical pitfalls and standardized technique protocol. Semin Nucl Med 1992, 22:74–84.

    Article  PubMed  CAS  Google Scholar 

  4. Kass EJ, Fink-Bennett D: Contemporary techniques for the radioisotopic evaluation of a dilated urinary tract. Urol Clin North Am 1990, 17:273–289.

    PubMed  CAS  Google Scholar 

  5. Grignon A, Filatrault D, Homsy Y, et al.: Ureteropelvic function stenosis: antenatal ultrasonographic diagnosis, post natal investigation and follow up. Radiology 1986, 160:649–654.

    PubMed  CAS  Google Scholar 

  6. King LR, Ansong K, Hanna MK: The case for immediate pyeloplasty in the neonate with ureteropelvic junction obstruction. J Urol 1984, 132:725–728.

    PubMed  CAS  Google Scholar 

  7. McCrory WW, Shibuya M, Leumann E, Karp R: Studies of renal function in children with chronic hydronephrosis. Pediatr Clin North Am 1971, 18:445–465.

    PubMed  CAS  Google Scholar 

  8. Mayor G, Genton N, Torrado A, Guignand JP: Renal function in obstructive nephropathy: long term effect of reconstruc-tive surgery. Pediatrics 1975, 56:740–747.

    PubMed  CAS  Google Scholar 

  9. Aperia A, Brokerger O, Wikstad I, et al.: Renal growth and function in patients nephrectomized in childhood. Acta Paediatr Scand 1977, 66:185.

    PubMed  CAS  Google Scholar 

  10. Kaufman JM, Siegel NJ, Hayslett JP: Functional and hemo-dynamic adaptation to progressive renal ablation. Circ Res 1975, 36:286–293.

    PubMed  CAS  Google Scholar 

  11. Aschrinberg LC, Koskimies O, Bernstein J, et al.: The influence of age on the response to renal parenchymal loss. Yale J Biol Med 1978, 51:341.

    Google Scholar 

  12. Larsson L, Aperia A, Wilton P: Effect of normal development on compensatory renal growth. Kidney Int 1980, 18:29–35.

    Article  PubMed  CAS  Google Scholar 

  13. Roth DR, Gonzales ET Jr: Management of ureteropelvic junction obstruction in infants. J Urol 1983, 129:108–110.

    PubMed  CAS  Google Scholar 

  14. Perez LM, Friedman RM, King LR: The case for relief of ureteropelvic junction obstruction in neonates and young children at the time of diagnosis. Urology 1991, 38:195–201.

    Article  PubMed  CAS  Google Scholar 

  15. Hsia T-Y, Shortliffe LMD: The effect of pregnancy rat urinary tract dynamics. J Urol 1995, 154:684–689.

    Article  PubMed  CAS  Google Scholar 

  16. Koff SA, Campbell K: Non-operative management of uni-lateral neonatal hydronephrosis. J Urol 1994, 152:525–531.

    Google Scholar 

  17. Koff SA, Campbell K: The non-operative management of uni-lateral hydronephrosis: natural history of poorly functioning kidneys. J Urol 1994, 152:593–595.

    PubMed  CAS  Google Scholar 

  18. Brandell RA, Brock JW III, Hamilton BD, et al.: Unilateral hydronephrosis in infants: are measurements of contra-lateral renal length useful? J Urol 1996, 156:188–189.

    Article  PubMed  CAS  Google Scholar 

  19. Fung LET, McLorie GA, Khoury AE, Churchill BM: Contra-dictory supranormal nuclear renographic differential renal function: fact or artifact? J Urol 1995, 154:667.

    Article  PubMed  CAS  Google Scholar 

  20. Ransley PG, Dhillon HK, Gordon I, et al.: The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol 1990, 144:584.

    PubMed  CAS  Google Scholar 

  21. Dhillon HKJ: Prenatally diagnosed hydronephrosis: the Great Ormand Street experience. Br J Urol 1998, 81(suppl):39–44. Outcome of patients randomized to early surgery or follow-up.

    PubMed  Google Scholar 

  22. Palmer LS, Maizels M, Cartwright PC, et al.: Surgery vs. observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol 1998, 159:222–228.

    Article  PubMed  CAS  Google Scholar 

  23. Peters CA, Lebowitz R, Bauer SB, et al.: Renal functional outcomes in prenatally diagnosed severe unilateral uretero-pelvic junction obstruction: a prospective study abstract. Paper presented at the Annual Meeting of the Academy of Pediatricians, October 17, 1998; San Francisco, CA.

  24. McAleer IM, Kaplan GW: Renal function before and after pyeloplasty: does it improve? J Urol 1999, 162:1041–1044.

    Article  PubMed  CAS  Google Scholar 

  25. Chertin B, Fridmans A, Knizhnik M, et al.: Does early detection of ureteropelvic junction obstruction improve surgical out-come in terms of renal function? J Urol 1999, 162:1037–1040. Recent report comparing early repair with latero pyeloplasty.

    Article  PubMed  CAS  Google Scholar 

  26. Fung LC, Khoury AE, McLorie GA, Churchill BM: Evaluation of pediatric hydronephrosis using individualized pressure flow criteria. J Urol 1995, 154:671–676.

    Article  PubMed  CAS  Google Scholar 

  27. Dejter SW, Gibbons MD: The fate of infant kidneys with fetal hydronephrosis but initially normal post natal sonography. J Urol 1989, 142:661–662.

    PubMed  Google Scholar 

  28. Flashner SC, Mesrobian H-GJ, Flatt JA, et al.: Nonobstructive dilatation of upper urinary tract may later convert to obstruction. Urology 1993, 42:569–573.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urology, University of New Mexico School of Medicine, 2211 Lomas Boulevard NE, 87131-5341, Albuquerque, NM, USA

    Lowell R. King MD

Authors
  1. Lowell R. King MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

King, L.R. Management of neonatal ureteropelvic junction obstruction. Curr Urol Rep 2, 106–112 (2001). https://doi.org/10.1007/s11934-001-0006-z

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-001-0006-z

Keywords

Search

Navigation