[The indications and choice for open surgical intervention in hydronephrotic transformation]

Out of the total of 372 patients treated for congenital and acquired hydronephrotic transformations over a three-year period (1990 through 1992), seventeen cases are subjected to treatment with antibiotics and antispasmodics followed by observation, and in 124 cases various types of open pyeloplastic procedures are performed. The indications for operative management of hydronephrotic transformation depends on the results of objective and laboratory studies, and subjective complaints. Accidentally discovered hydronephrotic transformations, I-II degree, may be subjected to conservative management followed by an observation period with good results. Of the 17 patients deterioration occurs in three cases, and in one of the latter nephrectomy is necessitated. In case of markedly expressed hydronephrotic transformation, associated with additional complications and renal function impairment, operation aimed at restoration of the patency of urinary tracts should be undertaken. Various types of pyeloplastic reconstructive interventions are performed, with the procedure suggested by Anderson-Hynnes, Foley and Davis being mainly used. In two patients secondary nephrectomy is done with a 96.8 per cent rate of successful outcomes.