Ureteropelvic junction obstruction: an objective approach to diagnosis and treatment

ABSTRACT

Favorable outcome of the management of ure-teropelvic junction [UPJ] obstruction depends upon early recognition of the disease and the proper selection of patients for operative or non operative treatment. Over the last 4 years, eighteen patients with confirmed or suspicious diagnosis of UPJ obstruction were referred for management at the pediatric Surgical Units in Ain Shams University, Cairo and the Arabian Oil Hospital Saudi Arabia. The first group [Group A] included twelve neonates with confirmed antenatal diagnosis of UPJ obstruction in 8 and suspected in 4, while the second group [Group B] included six children [aged 4 months to 6 years], 5 of whom were referred for evaluation of their urinary act infection and the sixth had pelvicalyceal dilatation on US done for his blunt abdominal trauma. According to the results of confirmatory US and diuretic renogram, obstructed kidneys were found in 15 patients, for whom Anderson-Hynes dismembered pyeloplasty was performed. The other 3 patients showed equivocal results, and were managed conservatively. All patients were followed up for 6 months to 4 years. Following surgery, neonates had better improvement of their renal functions than children. Conservative treatment yielded good results in 2 patients, while the third [a neonate] had pyeloplasty 6 months later.Our data emphasize the importance of antenatal diagnosis of UPJ obstruction to initiate prompt postnatal diagnosis of UPJ obstruction to initiate prompt postnatal work up and the significance of diagnosing the obstruction objectively, so as to select the patients for operative or non operative treatment