Related Experiment Videos
Managing apparent ureteropelvic junction obstruction in the newborn
P C Cartwright1, J W Duckett, M A Keating
1Division of Urology, Children's Hospital of Philadelphia, Pennsylvania 19104.
The Journal of Urology
|October 1, 1992
Summary
For newborns with ureteropelvic junction obstruction and good kidney function, nonoperative management with monitoring is a reasonable approach. This strategy prevents permanent loss of differential function, with surgery reserved for cases of declining function or complications.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Ureteropelvic junction obstruction (UPJO) is a common congenital anomaly.
- Management strategies for UPJO in neonates vary.
- Assessing differential renal function is crucial for guiding treatment.
Purpose of the Study:
- To evaluate the outcomes of nonoperative management versus early pyeloplasty in neonates with apparent UPJO.
- To determine if nonoperative management leads to permanent loss of renal function.
Main Methods:
- Retrospective review of 97 newborns with apparent UPJO.
- Patients with good initial differential function (>35%) were managed nonoperatively or underwent early pyeloplasty.
- Differential function and extraction factor were assessed using diethylenetriaminepentaacetic acid (DTPA) scans.
Main Results:
- 15% of nonoperatively managed patients eventually required pyeloplasty due to declining function, infection, or colic.
- No statistically significant difference in eventual differential function or extraction factor was observed between nonoperative and early surgery groups.
- Nonoperative management resulted in no permanent loss of function in kidneys with good initial function.
Conclusions:
- Initial nonoperative management with sequential renal scan follow-up is a reasonable approach for neonates with apparent UPJO and good differential function.
- Pyeloplasty should be reserved for cases with diminishing function, recurrent infections, or symptomatic colic.
- This approach ensures no permanent loss of renal function.