Surgery of pelviureteric obstruction in the first year of life

Twenty-nine out of 108 patients (26%) were under 1 year of age at the time of surgery for congenital pelviureteric obstruction. The clinical features and diagnosis, management, follow-up and results in these patients are reviewed. Clinical presentation was usually with an abdominal mass or urinary infection but an increasing number of cases were diagnosed after maternal ultrasonography had shown hydronephrosis. Ultrasonography, together with renal nuclide scan, were considered to be the most appropriate imaging modalities to define anatomy, determine function and document obstruction. Pyeloplasty was carried out successfully in 28 patients (two bilateral) and one patient had a nephrectomy. Sixteen pyeloplasties were managed by a nephrostomy (with or without a stent), the tubes usually being removed 10-12 days postoperatively. Fourteen pyeloplasties were managed by a wound drain only but one required a secondary nephrostomy although eventual recovery was satisfactory. Renal nuclide scan was found to be the most appropriate follow-up test and the overall results of surgery were satisfactory.