Broncoscopia pediátrica: de dónde venimos, hacia dónde vamos / Paediatric bronchoscopy: from where we came from, to where we are going

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Antenatal and postnatal management of congenital cystic adenomatoid malformation.

Congenital thoracic malformations (CTMs) are a heterogeneous group of rare disorders that may involve the airways or lung parenchyma. The authors have focused on the condition that causes the most controversy, namely, congenital cystic adenomatoid malformation (CCAM). The reported incidence is 3.5 and 0.94 per 10,000 live births for CTMs and CCAMs respectively. Ultrasound is the antenatal imaging modality of choice for screening for CCAMs whilst magnetic resonance imaging is complimentary for morphological and volumetric evaluation of the foetal lung. Most CCAMs are detected antenatally with only a small proportion presenting postnatally. Only a few CCAMs cause foetal problems, with foetal hydrops being the best predictor of death. Although many CCAMs regress during pregnancy, most remain detectable postnatally by CT scans. Surgical excision of symptomatic lesions is relatively straightforward, but management of asymptomatic lesions is controversial. Some surgeons adopt a "wait and see" approach operating only on those patients who develop symptoms, but others operate on asymptomatic patients usually within the first year of life. Due to the potential of malignant transformation, children should have long term follow up. There is an urgent need to delineate the natural history of antenatally detected CCAMs to guide future management.

Congenital diaphragmatic hernia.

Infants with congenital diaphragmatic hernia (CDH) have significant mortality and long-term morbidity. Only 60-70% survive and usually those in high-volume centres. The current Task Force, therefore, has convened experts to evaluate the current literature and make recommendations on both the antenatal and post-natal management of CDH. The incidence of CDH varies from 1.7 to 5.7 per 10,000 live-born infants depending on the study population. Antenatal ultrasound scanning is routine and increasingly complemented by the use of magnetic resonance imaging. For isolated CDH, antenatal interventions should be considered, but the techniques need vigorous evaluation. After birth, management protocols are often used and have improved outcome in nonrandomised studies, but immediate intubation at birth and gentle ventilation are important. Pulmonary hypertension is common and its optimal management is crucial as its severity predicts the outcome. Usually, surgery is delayed to allow optimal medical stabilisation. The role of minimal invasive post-natal surgery remains to be further defined. There are differences in opinion about whether extracorporeal membrane oxygenation improves outcome. Survivors of CDH can have a high incidence of comorbidities; thus, multidisciplinary follow-up is recommended. Multicentre international trials are necessary to optimise the antenatal and post-natal management of CDH patients.

The management of tracheobronchial obstruction in children.

Tracheobronchial obstruction is very uncommon in children and small infants. Stenosis and malacia, either congenital or acquired, are probably the most frequent diagnosis in this setting. Clinical symptoms are common to both airway anomalies and bronchoscopy plays a crucial role in the diagnostic work-up. Management is complex and surgeons involved in it should be familiar with multiple surgical and endoscopical techniques. Symptomatic short tracheal stenosis are best treated by means of resection and reconstruction, although endoscopic dilation or laser resection can be tried first in selected cases. In long tracheal stenosis, slide tracheoplasty is the surgical procedure of choice. Tracheobronchial malacia is usually self-limiting by the age of 3 years and most cases show mild symptoms that can be treated conservatively. In a small group of patients airway compromise is severe enough to require surgical or endoscopical treatment. Aortopexy or tracheostomy are the classic treatments for congenital tracheomalacia, but increasing experience with endoscopic airway stent placement in children is making this technique more attractive and popular. Acquired tracheomalacia is usually caused by a long-standing tracheostomy and if decannulation is impaired surgical treatment is mandatory.

Surgical management of severe suprastomal cricotracheal collapse complicating pediatric tracheostomy.

OBJECTIVE: Suprastomal tracheal collapse may interfere with decannulation in tracheostomized patients. The purposes of the study are to evaluate the role of tracheotomy technique in the ethiology of suprastomal cricotracheal collapse and to report our results in the treatment of this complication. METHODS: A retrospective review of children showing severe suprastomal collapse during the period 1990-2007, in a tertiary care children's hospital, was performed. Medical records were assessed for the following data: sex, age, original indication for tracheotomy, surgical technique, endoscopic findings, type of surgical correction, complications, result, and follow-up. RESULTS: Fourteen patients were included in the study, nine girls and five boys. Average age at tracheotomy was 17 months (range: 21 days-8 years), and prolonged ventilatory support was the most common indication (57%). Horizontal H-type tracheotomy was the most frequent technique in patients with suprastomal collapse (n=9), whereas only one patient with a vertical tracheotomy showed this complication (p<0.05). In every case bronchoscopy disclosed a suprastomal tracheal obstruction of at least 50% of the lumen. Mean age at surgical decannulation was 38 months (range: 12-147 months). Two surgical techniques have been used in the treatment of suprastomal collapse: anterior cricotracheal suspension (n=13) and reconstruction with autologous cartilage graft (n=1). All the patients were successfully decannulated although in one case two procedures were required. No recurrence has been observed during long-term follow-up (mean: 8.6 years). CONCLUSIONS: Endoscopical examination is essential for the diagnosis of suprastomal collapse and to rule out other causes of decannulation failure. In our experience, the tracheotomy technique seems to have an ethiologic role, and anterior cricotracheal suspension is a simple and effective procedure in the treatment of this tracheostomy related complication.

[Acquired tracheal stenosis: diagnosis and treatment]. / Estenosis traqueal adquirida: estrategia diagnóstica y terapéutica.

BACKGROUND: Acquired tracheal stenosis (ATS) is a very unfrequent lesion in the pediatric age group and may be due to diverse causes. Herein, we show our experience in the management of this entity. PATIENTS AND METHODS: We have reviewed the clinical charts of patients diagnosed of ATS in a single institution during the period 1991-2005. The following features have been taken into account: sex, age at diagnosis, ethiology, localization, morphologic type, symptomatology, associated anomalies, type of treatment, complications, results, and time of follow-up. RESULTS: Ten patients were included in the study, 5 boys and 5 girls. Median age at diagnosis was 6 years (range lmonth-14 years). In five cases, stenosis was due to tracheal intubation, two were postsurgical, one associated to Wegener disease, another caused by a foreign body, and the last was idyopathic. In 6 cases the lesion was located in the cervical trachea, in another two it was originated in the mid-trachea, and in the other 2 in the distal trachea. According to the morphologic type of stenosis, 6 cases were of the inflammatory type, 2 cases were of the diaphragm pattern, and another two were of the "bottle neck" type. Two patients have shown severe respiratory distress and the other 8 showed moderate symptoms. Three cases (30%) had congenital associated anomalies. In 9 patients an endoscopic treatment has been performed and 4 cases were surgically treated. In 3 cases both types of treatment were performed. Results have been satisfactory in 9 cases (90%) and bad in one patient. Mean time of follow-up has been 5,3 years (range 1 year- 10 years). CONCLUSIONS: Although it is a rare lesion, tracheal stenosis should be ruled out in every patient who has been intubated recently and shows stridor or dyspnea. Type of treatment depends on the ethiology and the morphologic characteristics of the stenosis.

Estenosis traqueal adquirida: estrategia diagnóstica y terapéutica / Acquired tracheal stenosis: diagnosis and treatment

Introducción. La estenosis traqueal adquirida (EA) es muy poco frecuente en la edad pediátrica pudiendo responder a múltiples causas. Mostramos nuestra experiencia en el manejo de esta patología, analizando los resultados obtenidos y estableciendo una adecuada estrategia diagnóstica y terapéutica. Material y métodos. Estudio retrospectivo de pacientes con diagnóstico broncoscópico de estenosis traqueal de causa adquirida en el período 1991-2005. Se han valorado los siguientes parámetros: sexo, edad, etiología, localización, tipo morfológico, afectación clínica, anomalías asociadas, forma de tratamiento, complicaciones, resultado y tiempo de evolución. Resultados. Diez pacientes han sido diagnosticados de EA: 5 niñas y 5 niños. La mediana de edad en el diagnóstico ha sido 6 años (rango: 1 mes-14 años). Cinco estenosis han sido postintubación, dos posquirúrgicas, una secundaria a enfermedad de Wegener, otra a cuerpo extraño enclavado en la mucosa traqueal, y el restante ha sido de causa idiopática. La localización de la lesión ha sido en tráquea cervical en 6 casos, en tercio medio en 2 y en otros dos casos traqueal distal. El tipo morfológico ha sido inflamatorio en 6 pacientes (60%), estenosis tipo membrana en dos casos y en “cuello de botella” en los dos restantes. Dos pacientes han presentado sintomatología respiratoria grave (20%) y ocho clínica moderada. Tres casos (30%) han presentado anomalías congénitas asociadas. En 9 pacientes (90%) se ha realizado un tratamiento endoscópico (dilatación, láser o prótesis) y en 4 casos (40%) cirugía (resección de la estenosis). En 3 pacientes se emplearon los dos tipos de tratamiento. El resultado ha sido satisfactorio en 9 casos (90%) y malo en uno. El tiempo de seguimiento medio ha sido de 5,3 años (rango 4 meses-10 años). Conclusiones. Aún siendo una patología muy poco frecuente, se debe descartar una estenosis traqueal en aquel paciente que presente estridor o disnea y haya sido intubado recientemente, siendo la traqueobroncoscopia el método diagnóstico de elección. La etiología de la lesión y sus características morfológicas condicionan la elección del tipo de tratamiento (AU)

Background. Acquired tracheal stenosis (ATS) is a very unfrequent lesion in the pediatric age group and may be due to diverse causes. Herein, we show our experience in the management of this entity. Patients and methods. We have reviewed the clinical charts of patients diagnosed of ATS in a single institution during the period 1991-2005. The following features have been taken into account: sex, age at diagnosis, ethiology, localization, morphologic type, symptomatology, associated anomalies, type of treatment, complications, results, and time of follow-up. Results. Ten patients were included in the study, 5 boys and 5 girls. Median age at diagnosis was 6 years (range 1month-14 years). In five cases, stenosis was due to tracheal intubation, two were postsurgical, one associated to Wegener disease, another caused by a foreign body, and the last was idyopathic. In 6 cases the lesion was located in the cervical trachea, in another two it was originated in the mid-trachea, and in the other 2 in the distal trachea. According to the morphologic type of stenosis, 6 cases were of the inflammatory type, 2 cases were of the diaphragm pattern, and another two were of the “bottle neck” type. Two patients have shown severe respiratory distress and the other 8 showed moderate symptoms. Three cases (30%) had congenital associated anomalies. In 9 patients an endoscopic treatment has been performed and 4 cases were surgically treated. In 3 cases both types of treatment were performed. Results have been satisfactory in 9 cases (90%) and bad in one patient. Mean time of follow-up has been 5,3 years (range 1 year- 10 years). Conclusions. Although it is a rare lesion, tracheal stenosis should be ruled out in every patient who has been intubated recently and shows stridor or dyspnea. Type of treatment depends on the ethiology and the morphologic characteristics of the stenosis (AU)

[Surgical decannulation of children with suprastomal collapse: review of our experience]. / Decanulación quirúrgica en el tratamiento del colapso traqueal supraestomal: revisión de nuestra experiencia.

BACKGROUND: Suprastomal tracheal collapse (STC) may interfere with decannulation in tracheostomized patients. AIM: To evaluate the role of tracheotomy technique in the ethiology of STC, and to analyze our results in the treatment of this complication. PATIENTS AND METHODS: We have studied the clinical charts of tracheostomized patients in our Unit, between 1990 and 2006, who showed significant STC impairing decannulation. The following data have been taken into account: sex, age, tracheotomy indication, surgical technique, endoscopic findings, type of surgical correction, complications, result, and follow-up. RESULTS: Thirteen patients have showed STC, nine girls and four boys. Average age when tracheotomy was performed was 18 months, and extended ventilatory support was the most common indication (61,5%). Tracheotomy with lateral flaps was the most frequent technique in this group of patients with STC (8 cases), whereas only one patient in whom an anterior vertical tracheal incision was performed showed this complication. In every case bronchoscopy disclosed a suprastomal tracheal obstruction of at least 50% of the lumen. Mean age when surgical decannulation was performed was 36 months (range, 12-147). Two surgical techniques have been used in the treatment of STC: anterior cricoid suspension (12 patients) and reconstruction with autologous cartilage graft (one case). A satisfactory result has been achieved in 92% of cases (one patient showed persistent collapse and the same procedure was repeated). Mean follow-is 8,6 years (range, 2 months-12 years). CONCLUSIONS: STC is a type of acquired tracheomalacia and presents in around 10% of tracheostomized patients. Bronchoscopy is essential for diagnosis and to rule out other causes of failure in decannulation. Tracheotomy technique seems to have an ethiologic role, and our preferred treatment, when sufficient cartilaginous support is present, is anterior cricoid suspension.

[Management of congenital tracheomalacia: a single institution experience]. / Traqueomalacia congénita: análisis de nuestra serie.

INTRODUCTION: Congenital tracheomalacia (CTM) is a rare disease causing tracheal wall collapse when breathing. Herein, we show our experience in the management of this type of airway anomaly, settling the indications for surgical or endoscopic treatment. PATIENTS AND METHODS: We have performed a retrospective study, from 1991 to 2003, of patients with a bronchoscopic diagnosis of CTM or bronchomalacia (BM). We have analyzed the following facts: sex, age, indication of the initial bronchoscopy, ethiology, clinical group, anatomic type, associated malformations, treatment modality, complications, results, and time of follow-up. RESULTS: 46 patients have been included in this study: 25 boys (54%) and 21 girls (45%). Mean age at diagnosis has been 11 months. The indications for diagnostic bronchoscopy have been: respiratory distress (24%), lung athelectasia (24%), stridor (21%), congenital tracheoesophageal fistula (11%), extubation failure (11%), apneic spells (6%), and recurrent pneumonia (2%). Secondary CTM has been much more frequent (82%) than the primary type (17%). Patients have been classified into 3 groups according to the severity of symptoms: group I--mild symptoms (7 patients); group II---moderate (22); and group III, severe (17). Tracheomalacia was diagnosed in 26 cases (56%), bronchomalacia in 12 (26%) and tracheobronchomalacia in 8 patients (17%). Almost all the patients (95%) have showed other associated malformations. Medical treatment has been instituted in 29 patients (63%), 15 cases (32%) have been managed surgically or endoscopically, and in 2 cases no treatment was tried because of their critical clinical status. In addition, in 17 patients (37%) an antireflux surgical procedure was performed. Satisfactory results have been achieved in 72% of treated patients, fair results were obtained in 4 (9%), and a poor outcome occurred in 2 (4,5%). Another 8 patients have died during follow-up due to unrelated causes. 36 patients (78%) are alive with a mean follow-up period of 5,3 years. CONCLUSIONS: Most patients with CTM can he treated conservatively though spontaneous resolution may he expected after the first year of life. Surgical or endoscopical procedures are indicated in those patients with severe respiratory symptoms.

Traqueomalacia congénita: análisis de nuestra serie / Management of congenital tracheomalacia: a single institution experience

Introducción. La traqueomalacia congénita (TMC) es una entidad poco frecuente que se caracteriza por la existencia de colapso de la pared traqueal durante la espiración. Objetivo. Mostrar nuestra experiencia en el manejo de esta patología, estableciendo los criterios para el tratamiento quirúrgico o endoscópico, y analizando los resultados a largo plazo. Material y métodos. Hemos realizado un estudio retrospectivo de pacientes con diagnóstico broncoscópico de TMC en el periodo 1991-2003. Los siguientes parámetros han sido analizados: sexo, edad, indicación de la broncoscopia diagnóstica, etiología, grupo clínico, tipo anatómico, malformaciones asociadas, forma de tratamiento, complicaciones, resultados y tiempo de seguimiento. Resultados. 46 pacientes han sido diagnosticados de TMC: 25 varones (54%) y 21 niñas (45%). La edad media de diagnóstico ha sido de 11 meses. La indicación de la broncoscopia diagnóstica ha sido: atelectasia (24%), dificultad respiratoria (24%), estridor (21%), sospecha de FTE (11%), fracaso de extubación (11%), pausas de apnea (6%) y neumonía recurrente (2%). La TMC ha sido primaria en 8 pacientes (17%) y secundaria en 38 (82%). La repercusión clínica se ha clasificado en tres grupos: grupo I, leve (7 casos); grupo ll, moderada (22 casos) y grupo III, grave (17 casos). La afectación ha sido traqueal en 26 pacientes (56%), bronquial en 12 (26%) y traqueobronquial en 8 casos (17%). El 95% de los pacientes han presentado malformaciones asociadas. El 63% (29 casos) se han tratado de forma conservadora, 15 pacientes (32%) han sido tratados con procedimientos quirúrgicos y/o prótesis endoluminales, y en 2 casos no fue posible instaurar un tratamiento. Además, en 17 pacientes (37%) se realizó una técnica quirúrgica antirreflujo. El resultado ha sido bueno en el 72% de los casos tratados, regular en 4 (9%) y malo en 2 (4,5%). Otros 8 pacientes han fallecido por otros motivos ajenos a su malacia. La supervivencia global ha sido del 78%. El periodo de seguimiento medio ha sido de 5,3 años. Discusión. La mayoría de los pacientes con TMC se pueden tratar de forma expectante, ya que a partir del primer año de vida se produce una mejoría clínica espontánea. El tratamiento quirúrgico o endoscópico se reserva para los casos con grave compromiso respiratorio (AU)

Introduction. Congenital tracheomalacia (CTM) is a rare disease causing tracheal wall collapse when breathing. Herein, we show our experience in the management of this type of airway anomaly, settling the indications for surgical or endoscopic treatment. Patients and methods. We have performed a retrospective study, from 1991 to 2003, of patients with a bronchoscopic diagnosis of CTM or bronchomalacia (BM). We have analyzed the following facts: sex, age, indication of the initial bronchoscopy, ethiology, clinical group, anatomic type, associated malformations, treatment modality, complications, results, and time of follow-up. Results. 46 patients have been included in this study: 25 boys (54%) and 21 girls (45%). Mean age at diagnosis has been 11 months.The indications for diagnostic bronchoscopy have been: respiratory distress (24%), lung athelectasia (24%), stridor (21%), congenital tracheoesophageal fistula (11%), extubation failure (11%), apneic spells (6%), and recurrent pneumonia (2%). Secondary CTM has been much more frequent (82%) than the primary type (17%). Patients have been classified into 3 groups according to the severity of symptoms: group I -mild symptoms (7 patients); group Il-moderate (22); and group III, severe (17). Tracheomalacia was diagnosed in 26 cases (56%), bronchomalacia in 12 (26%) and tracheobronchomalacia in 8 patients (17%). Almost all the patients (95%) have showed other associated malformations. Medical treatment has been instituted in 29 patients (63%), 15 cases (32%) have been managed surgically or endoscopically, and in 2 cases no treatment was tried because of their critical clinical status. In addition, in 17 patients (37%) an antireflux surgical procedure was performed. Satisfactory results have been achieved in 72% of treated patients, fair results were obtained in 4 (9%), and a poor outcome occurred in 2 (4,5%). Another 8 patients have died during follow-up due to unrelated causes. 36 patients (78%) are alive with a mean follow-up period of 5,3 years. Conclusions. Most patients with CTM can he treated conservatively though spontaneous resolution may he expected after the first year of life. Surgical or endoscopical procedures are indicated in those patients with severe respiratory symptoms (AU)

Splenic littoral cell angioma in an infant.

A 1-year-old girl presented with fever, asthenia, and splenomegaly with hypersplenism. Abdominal ultrasound scan and magnetic resonance imaging showed multiple nodular cystic masses in an enlarged spleen. The histological examination of the resected spleen showed a novel type of vascular tumor called littoral cell angioma. The histopathologic and immunohistochemical features of this rare lesion are described. Distinction from other splenic vascular tumors is stressed because the clinical behavior of this new entity seems to be benign.

[Surgery of lung metastasis]. / La cirugía de las metástasis pulmonares.

INTRODUCTION: The 30-40% of the oncologic patients have pulmonary metastases. Lung can be the only organ affected. In selected patients, exeresis of the pulmonary nodules can mean their healing. MATERIAL AND METHODS: Between 1982-1997, twenty two patients presented metastases, 13 could be operated and 16 thoracotomies were done. There were 53% boys and 47% girls whose ages ranged from 3 to 15 years. We have considered: pulmonary tumour location, disease free interval, number of metastases, surgical technique and incomplete pulmonary tumour resection. RESULTS: Primary tumours were: Wilms tumours 23%, bone tumours 67% (Ewing and osteosarcoma). Disease free interval was < 2 years in 8 patients (61%) and > 2 years in 39%. X-Ray and CT were performed in every case and 66% presented a solitary nodule. Surgical techniques were: metastasectomy in two cases (12%), wedge resection in 8 (50%) and lobectomy in six cases (38%). We made thoracoscopy in two patients. There weren't postoperatory mortality but the patients with tumorectomy had an incomplete surgical resection. The overall survival is 54 percent and the 5 years survival is 23 percent (3 patients). CONCLUSIONS: The patients with a DFI < 2 years have a survival of 25% compared with 100% for patients who have a DFI > 2 years. The pulmonary resection in selected patients can offer better survival. We can use the thoracoscopy in same selected patients.

Bronchial mucoepidermoid tumor in a 3-year-old child.

A 3-year-old girl was evaluated for persistent middle lobe atelectasis. Fiberoptic bronchoscopy revealed a spherical mass occupying the middle-lobe bronchus. The biopsy specimen disclosed a low-grade mucoepidermoid carcinoma. A lobectomy was performed. The patient is in good condition 2 years after the operation. Mucoepidermoid tumors are rare bronchial adenomas comprising 1% of all lung neoplasms. Children are very infrequently affected. The clinical behavior of these tumors is controversial. Surgical resection of the low-grade-type tumor has an excellent prognosis.

Synovial sarcoma of the esophagus.

A 14-year-old girl presented with dysphagia and weight loss. Barium swallow, computed tomography, and endoscopy showed a polypoid intraluminal mass in the cervical esophagus. The tumor was locally resected and postoperative chemotherapy and radiotherapy were administered. Histological examination of the surgical specimen established a diagnosis of synovial sarcoma. The patient remains free of discernible disease 30 months after surgery. Esophageal sarcomas are rare tumors. This appears to be the second reported case of esophageal synovial sarcoma in a child.

[Complete urethral duplication in a girl]. / Duplicación uretral completa en una niña.

Urethral duplication is a very rare malformation which occurs almost exclusively in males. Associated genital and urinary malformations are frequent, and the approach in symptomatic cases in surgical management. This paper presents one case of a full double urethra in a 9-year old girl with repeat urinary infections and incontinence. The accessory urethra was surgically removed using perianal and abdominal access. Evolution has been favourable with disappearance of symptomatology.

Neonatal pulmonary blastoma.

A thoracic mass was identified on a routine ultrasound (US) examination in the 30th week of gestation. A postnatal chest radiograph, US, and computed tomography demonstrated a well-delineated, solid, cystic tumor in the left lower lobe. The mass was excised and a diagnosis of pulmonary blastoma (PB) was made on pathologic examination. The patient is alive and free of disease 8 years after the operation. PB is a rare primary neoplasm of the lung, adults being more frequently affected than children. This case appears to be the third neonatal PB reported and one of the few long-term survivors.

[Fetal cystic neuroblastoma]. / Neuroblastoma quístico fetal.

Neuroblastoma is the most common malignant solid tumor in infants less than 1 year old. A case of adrenal cystic neuroblastoma detected by ultrasound in the 37 th week of pregnancy, is reported. The sonographic features of fetal neuroblastoma range from solid to cystic or complex lesions. Early detection of the tumor by prenatal ultrasound permits prompt neonatal treatment and a better outcome.

[Clinical course of primary non-obstructive megaureter: analysis of our series]. / Evolución del megauréter primario no obstructivo: análisis de nuestra serie.

Due to the widespread use of obstetrical ultrasonography with concomitant fetal screening, congenital uropathies are usually diagnosed in asymptomatic neonates. The main issue is to distinguish those cases of dilatation which are clearly obstructive and need surgical treatment from those which are within the normal anatomical range. Out of 47 patients with primary megaureter, 23 were nonobstructive, these are the aim of our study. There were 16 males and 7 females; 13 were located on the left side, 7 on the right side and 3 were bilateral, adding up to 26 reno-ureteral units. Prenatal diagnosis was performed in 16 cases, the eldest patient diagnosed was nine. All infants were evaluated with ultrasonography, voiding cystourethrography, excretory urography and diuresis renography. The latter has been the most important test inducing us to adopt a conservative attitude. Differential renal function was more than 40% in 24 units and in 2 was more than 35%. Diuretic renograms were type IIIa (Dilated non obstructed) in 19 cases and IIIb (Dilated partially obstructed) in 7. There were 2 cases with vesicoureteral reflux in the contralateral system. We have performed ultrasonography and diuresis renography during the follow-up. There were 8 cases with type I (Normal) renograms and 17 cases with type IIIa. Only one patient developed an obstruction and was operated on. In every case differential renal function did not deteriorate. In 9 cases urography was performed in order to see the anatomical changes. They have remained asymptomatic during the follow-up except for two cases which presented urinary tract infection. BUN, creatinine and other biochemical figures remained within normal ranges.(ABSTRACT TRUNCATED AT 250 WORDS)