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KMID : 0358320100510090653
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Korean Journal of Urology
2010 Volume.51 No. 9 p.653 ~ p.656
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Management of Severe Bilateral Ureteropelvic Junction Obstruction in Neonates with Prenatally Diagnosed Bilateral Hydronephrosis
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Kim Jong-Won
Hong Sung-Woo
Park Chang-Hoo
Park Hong-Zoo
Kim Kun-Suk
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Abstract
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PurposeThe management of prenatally detected bilateral ureteropelvic junction obstruction (UPJO) remains controversial. We attempted to develop a treatment plan for patients with severe bilateral UPJO.
Materials and MethodsWe evaluated the records of 13 patients with prenatally diagnosed grade 3 or more bilateral hydronephrosis that led to the postnatal diagnosis of severe bilateral UPJO. Ultrasonography and 99mtechnetium mercaptoacetyltriglycine (99mTc-MAG3) renal scans were performed within 1 month. Four renal units had grade 3 and 22 had grade 4 hydronephrosis. All 13 patients were managed by unilateral pyeloplasty, and the patients’ mean age was 3 months. At 1 month postoperatively, we decided whether delayed surgery in the opposite renal unit was necessary according to the findings of ultrasonography and 99mTc-MAG3 scans.
ResultsOf 13 patients, 11 underwent initial pyeloplasty on renal units with more severe hydronephrosis or lower relative renal function (RRF) on 99mTc-MAG3 scans. The remaining 2 patients simultaneously underwent percutaneous nephrostomy on renal units with a lower RRF and initial pyeloplasty on renal units with a higher RRF. In 5 patients, contralateral hydronephrosis had spontaneously improved at 1 month postoperatively, and 8 patients underwent delayed contralateral pyeloplasty at 2 months postoperatively.
Conclusions
In children with severe bilateral UPJO, the non-operated renal units with grade 3 and some with grade 4 hydronephrosis improved spontaneously after unilateral pyeloplasty. Therefore, delayed pyeloplasty of the opposite side should be considered at 1 month following initial pyeloplasty.
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KEYWORD
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Hydronephrosis, Ultrasonography, Ureteral obstruction
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