[Hydronephrosis surgically treated in the 1st year of life. Short- and long-term radiologic and functional...

Hydronephrosis in infancy and childhood is a frequent urinary malformation and is almost always congenital. In over 80% of the cases it is due to ureteropelvic junction obstruction; much less frequently it is due to anomalous renal vessels, sometimes associated to ureteropelvic junction obstruction. In this paper the Authors analyze their experience in the surgical treatment of this urinary malformation. 234 hydronephrosis out of 222 patients were operated on from January 1972 to June 1985. 61 hydronephrosis were operated on in 55 infants under 1 year. Primary nephrectomy was carried out only in 9 of the 234 hydronephrosis operated on (3.9%) and in 3 of the 61 hydronephrosis operated on in infants less than 1 year old (4.9%). All the 55 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants but one showed a significant radiological improvement after pyeloplasty. 28 infants for a total of 30 hydronephrosis had a glomerular filtration rate determination during sequential scan for individual kidney function assessment. 90% of the kidneys operated on showed a normal or slightly reduced glomerular filtration rate. Recent advances in prenatal echographic diagnosis and relationship between obstructive uropathy, renal development and pulmonary hypoplasia are discussed. The Authors stress out the importance of early diagnosis to improve surgical results.