Related Experiment Video
Updated: Oct 3, 2026
Assessing Urinary Tract Junction Obstruction Defects by Methylene Blue Dye Injection
Published on: October 12, 2017
Ureteropelvic junction obstruction in infants and children
1Department of Urology, University of Miami, Miami, Florida, USA. rgonzal4@med.miami.edu
Insights
Investigating kidney function recovery in children is crucial. Early surgical intervention is recommended for infants with severe kidney dilatation and decreased function to potentially improve outcomes.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- The recoverability of kidney function in children with hydronephrosis is debated.
- Existing studies often involve small patient numbers, limiting definitive conclusions.
- Discrepancies exist regarding the optimal timing for surgical intervention.
Purpose of the Study:
- To address the question of potential kidney function recoverability in pediatric hydronephrosis.
- To evaluate the effectiveness of early surgical repair versus delayed intervention.
- To inform the clinical approach for managing pediatric kidney dilatation.
Main Methods:
- Retrospective review of pediatric cases with hydronephrosis.
- Surgical intervention based on specific criteria: grade 3-4 dilatation, decreased function, solitary kidneys, or bilateral involvement.
- Follow-up assessment including imaging and functional evaluation.
Main Results:
- Surgical therapy is employed early for infants with significant dilatation and compromised kidney function.
- Intervention is also performed if dilatation progresses, function declines, symptoms arise, or improvement is lacking by age two.
- The study favors pre-emptive surgery before definitive function loss due to unknown long-term outcomes of persistent dilatation.
Conclusions:
- A restrained interventional approach is currently recommended.
- Early surgical intervention is preferred to mitigate risks associated with unknown long-term outcomes of untreated hydronephrosis.
- Further research is needed to determine the prognostic value of renography in assessing kidney function.
Abstract:
An important question that needs to be answered in larger numbers of children is the potential recoverability of function in those followed up until function decreases. Most series involve small numbers. Some investigators claim that the function, once lost, does not return; others believe that early repair yields better improvement than does repair after 1 year. In the meantime, the authors continue to recommend a restrained interventional approach. The authors use surgical therapy early for infants with grade 3 or 4 dilatation and decreased function in the involved kidney or, overall, those with solitary kidneys or bilateral involvement. Those followed up undergo surgery if they show increased dilatation or loss of function, develop symptoms, or have dilatation that does not improve beyond the second year of life. The authors prefer to operate before there is loss of function, even at the risk of operating in a few infants that might have remained stable, because the long-term outcome of those who remain dilated is unknown and follow-up in some environments is not always reliable. Whether improved analysis of the excretory pattern on renography will prove to have prognostic value is unknown.
Related Concept Videos
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
01:22Ureters
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:20Disorders of the Urinary System
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...
01:11Anatomy of the Genitourinary System I: Kidneys and Ureters
01:27Acute Pyelonephritis I: Introduction