Antenatally detected, unilateral dilatation of the renal pelvis: a critical review. 2. postnatal non-operative treatment--long-term hazards, urgent research.
BACKGROUND
Even after two decades, there is still much discussion about the postnatal treatment of antenatally detected, isolated pelvic dilatation (consistent with pyelo-ureteral junction obstruction). A recent review concluded that non-operative expectancy seemed safe - even after 17 years in certain cases. However, the final outcome, i.e. when these children have reached old age, is remote.


OBJECTIVE
This review takes stock of conceivable long-term hazards and evaluates prognosticating tools, and offers a basis for protocols for future randomized controlled trials. Long-term hazards: Symptoms in this context are generally considered ominous. In the antenatally detected cases, i.e. primarily asymptomatic, symptoms have been reported but they were not necessarily combined with renal damage. Hydronephroses, so mild, that they are written off, may deteriorate later on (indeed insidiously), although probably seldom. Urgent research: A predictor of outcome is eagerly pursued but hard to obtain, due to the difficulty in defining true obstruction in compliant systems such as the urinary one. Ordinary diagnostics offer no help, but there are promising innovations: constant pressure/flow assessment (flow necessary to keep a preset intrapelvic pressure), NAG/creatinine in pelvic urine, and TGFbeta-1 in voided urine. Renal microstructure, sometimes severely damaged early (which disagrees with the good results with expectancies) could possibly herald future deterioration.


CONCLUSIONS
Adverse developments should be meticulously documented and published swiftly, so policy can be changed if necessary, before it is too late. Cognizance of their existence, not necessarily frequency and statistics, is then first order. Efforts to design prognosticating tools has also high priority.
Karolinska Institute, Stockholm, Sweden. staffan.josephson@kbh.ki.se
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Josephson
D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital / Q000175:diagnosis* / Q000628:therapy*; D007231:Infant, Newborn; D007677:Kidney Function Tests; D011247:Pregnancy; D011296:Prenatal Diagnosis; D011379:Prognosis; D012106:Research; D018570:Risk Assessment; D012720:Severity of Illness Index; D013548:Sweden