Prenatal ultrasound has led to earlier detection and repair of ureteropelvic junction obstruction.
OBJECTIVE
We hypothesized that the widespread adoption of prenatal ultrasound in the early 1980s has led to earlier and increased numbers of repairs for ureteropelvic junction (UPJ) obstruction.


METHODS
The New York State Department of Health database was used to identify all patients who underwent pyeloplasty between 1984 and 2002.


RESULTS
A total of 7,758 repairs were evaluated (6,725 pyeloplasties and 1,033 endopyelotomies). There was no substantial change in the rate of repair when adjusted for age specific population during the study period. The annual rate of repair in patients younger than 1 year increased from 94 to 156 per 100,000 live births between the periods 1984 to 1988 and 1989 to 2002. This same upward trend was seen in the children 1 to 9 years old. In contrast, there was a substantial decrease in the rate of repairs in patients 10 to 19 years old and in those 20 to 29 years old (from 10 to 9 per 100,000 and from 12 to 8 per 100,000 population, respectively). The male-to-female ratio of newborns in our series was approximately 3:1, which is consistent with previous reports. Among older patients males underwent fewer repairs such that the male-to-female ratio in patients older than 30 years was 1:2.


CONCLUSIONS
The overall rate of UPJ repair has not changed during the last 19 years, but there has been a substantial trend toward repair at an earlier age. This finding suggests that prenatal ultrasound has led to earlier diagnosis of UPJ obstruction, allowing earlier repair and obviating later repair. We also report the novel finding of a decreasing rate of pyeloplasty in males with age. This decrease was not observed in females.
Capello
Seth A
SA
Division of Urology, Albany Medical College, Albany, New York 12208, USA. capels@juno.com
Kogan
Barry A
BA
Giorgi
Louis J
LJ
Kaufman
Ronald P
RP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D007682:Kidney Pelvis; D008297:Male; D008875:Middle Aged; D016216:Ultrasonography, Prenatal; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging* / Q000601:surgery*