Postnatal unilateral pelviureteral junction obstruction: impact of pyeloplasty and conservative management on renal function.
OBJECTIVE
To study the effect of pyeloplasty and conservative management on renal function in children with pelviureteral junction obstruction.


METHODS
This prospective study included 65 children postnatally diagnosed with unilateral pelviureteral junction obstruction. On the basis of the patients' symptoms and technetium-99m diethylenetriamine pentaacetic acid renal isotope scan findings, symptomatic patients or those with split function of the corresponding kidney of 40% or less were assigned to group 1 (n = 35) and underwent pyeloplasty. Asymptomatic patients with split function greater than 40% (group 2, n = 30) were treated conservatively. Patients who showed deterioration of renal function underwent pyeloplasty. The effect of both lines of treatment on renal function was evaluated.


RESULTS
After pyeloplasty, group 1 had improvement in the glomerular filtration rate (GFR) in 30 (85.7%), stabilization in 2 (5.7%), and deterioration in 3 (8.6%) patients. In group 1, the comparison between the mean value of the baseline GFR (17.1 +/- 7.7 mL/min) and its mean value at follow-up (28 +/- 6.3 mL/min) showed an increase of statistical significance (P <0.01). In the group 2 patients, conservative treatment resulted in improvement in the GFR in 12 (40%), stabilization in 3 (10%), and deterioration in 15 (50%) patients. In group 2, no significant difference was found between the mean baseline GFR (29.8 +/- 9.8 mL/min) and its mean value at follow-up (31.2 +/- 5.6 mL/min).


CONCLUSIONS
In patients with postnatal pelviureteral junction obstruction, early pyeloplasty is recommended if the corresponding GFR is 40% or less. Conservative management in patients with better function resulted in deterioration of renal function in 50%. Should this policy of treatment be chosen, meticulous follow-up is mandatory.
Shokeir
Ahmed A
AA
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. ahmedshokeir@hotmail.com
El-Sherbiny
Mohamed T
MT
Gad
Hosam M
HM
Dawaba
Mohamed
M
Hafez
Ashraf T
AT
Taha
Mohamed A
MA
Saida
Mohamed
M
Ghaly
Ahmed M
AM
D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007668:Kidney / Q000503:physiopathology; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D011296:Prenatal Diagnosis; D011866:Radioisotope Renography; D014517:Ureteral Obstruction / Q000151:congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*