Salvage pyeloplasty in nonvisualizing hydronephrotic kidney secondary to ureteropelvic junction obstruction

The potential recoverability of an obstructed kidney detected by maternal antenatal ultrasound cannot be predicted by the currently available methods of investigation. Early repair in the presence of little parenchymal tissue may result in marked improvement in renal function. During the last 2 years 8 male and 2 female neonates with antenatal presentation of hydronephrosis were referred for postnatal evaluation. All patients had palpable renal masses clinically, which were unilateral (left side) in 9 and bilateral in 1. Blood urea nitrogen and creatinine were normal in all patients. Postnatal imaging included abdominal ultrasonography, voiding cystourethrography, excretory urography and quantitative functional evaluation with diuretic diethylenetriaminepentaacetic acid renal scan. Nonvisualization of a left hydronephrotic kidney was detected in all cases. Antegrade pyelography at surgical exploration (at age less than 2 months) was done to outline the anatomy. Stretched thinned out renal parenchymal tissue over a hugely distended renal pelvis was present and dismembered reduction pyeloureteroplasty was performed. A nephrostomy tube and ureteral stent were used. Followup ranged between 6 and 24 months. Remarkable recovery of renal function, more than 100% on renal scintigraphy, was noted postoperatively in all patients.