Natural history of pelviureteric obstruction detected by prenatal sonography.
Fifty-six infants with prenatally diagnosed hydronephrosis are reported. In all instances the diagnosis was confirmed postnatally and at renography 45 were obstructed; 38 obstructed kidneys (84%) and all of the non-obstructed kidneys had a differential function exceeding 40% of total function. Latterly we have come to recommend early pyeloplasty only if differential function of a renographically obstructed kidney is less than 40%; 6 early pyeloplasties were performed for this reason; 28 infants (30 renal units) were managed non-operatively and 18 of these (19 renal units) were reassessed renographically. In 11 the obstruction persists. Sonography demonstrated improving hydronephrosis in 8 kidneys with resolution in 5 and no change in 6. Of the other 10 infants (11 renal units), the hydronephrosis has improved in 4, resolved in 1 and remains unchanged in 6. Our experience suggests that neonatal and early pyeloplasty can be restricted to a modest number of infants in whom there is impaired renal function. In cases with normal function the natural history appears essentially benign and does not justify routine pyeloplasty.
Arnold
A J
AJ
Department of Paediatric Urology, Royal Liverpool Children's Hospital.
Rickwood
A M
AM
D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis*; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000209:etiology; D007231:Infant, Newborn; D007682:Kidney Pelvis / Q000473:pathology*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000150:complications / Q000175:diagnosis*