Delayed management of neonatal hydronephrosis.
There is healthy debate over the management and timing of surgical reconstruction in the neonate with hydronephrosis. We have seen 23 neonates (35 renal units) with antenatal or neonatal hydronephrosis secondary to ureteropelvic junction obstruction or megaureter since 1984. All renal units with postnatally confirmed hydronephrosis (78 per cent) were studied initially and serially with diuretic 99mtechnetium-diethylenetriaminepentaacetic acid renography and entered into a delayed management protocol. A total of 23 renal units followed for an average of 7 months before any surgical procedures were done demonstrated maturation of renal function. Of these cases 9 obstructed renal units (half-time greater than 20 minutes) underwent delayed reconstruction (6 with ureteropelvic junction obstruction and 3 with megaureter) at an average patient age of 6 months. In this group there was no compromise in renal function nor were any complications encountered. Two units with initially obstructive patterns on renography demonstrated improved drainage and have not required an operation to date. Twelve renal units with indeterminant (half-time 10 to 20 minutes) and nonobstructive (half-time less than 10 minutes) half-times also showed stable, maturing renal function. Delayed reconstruction in the neonate with ureteropelvic junction or megaureter obstruction and normal diethylenetriaminepentaacetic acid function is safe. In addition, a period of observation may obviate the need for an operation in some cases when ureteropelvic junction stabilization results in improved drainage. These as well as the added benefits of diminished anesthetic risk, enhanced technical ease, noninterrupted maternal-infant bonding and lower operative complication rate make this approach desirable in properly selected patients.
Dejter
S W
SW
Department of Surgery (Pediatric Urology), Georgetown University Children's Medical Center, Washington, D.C.
Eggli
D F
DF
Gibbons
M D
MD
D006801:Humans; D006869:Hydronephrosis / Q000209:etiology / Q000601:surgery*; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging / Q000254:growth & development / Q000503:physiopathology; D004369:Pentetic Acid; D011184:Postoperative Period; D011866:Radioisotope Renography; D013997:Time Factors; D014517:Ureteral Obstruction / Q000150:complications* / Q000503:physiopathology
D004369:Pentetic Acid