[Comparative characteristics of the course of upper obstructive uropathies diagnosed during the perinatal period]

Area of Science:

• Pediatric Urology
• Neonatal Surgery
• Diagnostic Imaging in Pediatrics

Background:

• Ureteropelvic junction obstruction (UPJO) and primary obstructed megaureter without reflux (POM) are common causes of congenital hydronephrosis in neonates.
• Prenatal diagnosis is increasingly common for both UPJO and POM, necessitating clear management guidelines.
• Understanding the natural history and diagnostic accuracy for these conditions is crucial for appropriate clinical decision-making.

Purpose of the Study:

• To compare the clinical presentation, management, and diagnostic accuracy of ureteropelvic junction obstruction (UPJO) and primary obstructed megaureter without reflux (POM) in neonates.
• To evaluate the potential for spontaneous resolution in cases of POM.
• To assess the utility of specific diagnostic tests in differentiating and managing these conditions.

Main Methods:

• Comparative study of two groups of 30 neonates each: one with UPJO, the other with POM.
• Review of prenatal diagnostic rates and surgical intervention requirements.
• Observation of spontaneous resolution and radiographic improvement timelines.
• Evaluation of Tc-DTPA renal diuretic scans and percutaneous pyelomanometry accuracy.

Main Results:

• Prenatal diagnosis was achieved in 80% of UPJO and 64% of POM cases.
• The majority of infants (19 UPJO, 24 POM) did not require immediate surgery and were managed conservatively.
• Spontaneous resolution was observed in POM, even in Grade III cases, which is contrary to UPJO.
• Radiographic improvement was generally noted between 3 and 4 months postnatally.
• Tc-DTPA renal diuretic scans and percutaneous pyelomanometry showed higher accuracy for UPJO compared to POM.

Conclusions:

• Primary obstructed megaureter (POM) in neonates has a higher likelihood of spontaneous resolution compared to ureteropelvic junction obstruction (UPJO).
• Conservative management is feasible for a significant proportion of neonates diagnosed with UPJO or POM.
• Diagnostic modalities like Tc-DTPA scans and pyelomanometry are more informative for UPJO than POM, highlighting the need for tailored diagnostic approaches.