Pediatric urethropelvic junction obstruction - an update.
Maternal-fetal ultrasound has dramatically increased the detection of asymptomatic ureteropelvic junction obstruction. Techniques to assess obstruction and function in the pediatric kidney are imperfect and only recently have diuretic renography and ultrasound been standardized. Considerable controversy has arisen regarding the need for and appropriate timing of surgical correction in pediatric asymptomatic ureteropelvic junction obstruction. Experimental research has suggested that the reninangiotensin system and perhaps growth factors play a role in the response to congenital asymptomatic ureteropelvic junction obstruction. Until several large-scale prospective clinical studies in North America and Britain come to fruition, many aspects of this condition will remain poorly understood.
MacNeily
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Assistant Professor of Urology and Pediatrics, Queen's University, Kingston, Ontario.