title: The effect of preoperative urinary tract infection on postoperative renal function in prenatally diagnosed ureteropelvic junction obstruction: Indications for the timing of pyeloplasty.
abstract: OBJECTIVE
  We reviewed renal function after pyeloplasty (PP) in cases of prenatally diagnosed ureteropelvic junction obstruction (PDUPJO) to determine the impact of preoperative urinary tract infection (UTI) on the timing of PP.
  
  
  METHODS
  We retrospectively reviewed 81 cases of PDUPJO diagnosed between 1998 and 2013. Incidence of UTI was used to divide 37 kidneys requiring PP (3 bilateral) into U(-): UTI≤1; n=25, and U(+): UTI≥2; n=12 to compare age at PP, grade of hydronephrosis (HN) on ultrasonography (US), glomerular filtration rate (GFR) on diethylenetriaminepentacetic acid (DTPA) renography, and uptake on dimercaptosuccinic acid (DMSA) scintigraphy pre/post PP.
  
  
  RESULTS
  Age at first UTI and age at PP were similar. HN improved significantly postPP in all cases. Although DTPA and DMSA were similar prePP, improvement postPP was better in U(-) than U(+), but only DMSA in U(-) was statistically significant (15.2%±4.0% vs. 20%±3.7%; p=0.049). There were no complications or UTI postPP.
  
  
  CONCLUSIONS
  Two or more UTIs would appear to be associated with postPP renal dysfunction in PDUPJO. Thus, PP should be performed after the initial UTI but before the second UTI.
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Suda
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: h-koga@juntendo.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koga
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Okawada
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lane
authors.affiliation: Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Yamataka
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007668:Kidney / Q000502:physiology* / Q000601:surgery; D007677:Kidney Function Tests; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D057234:Preoperative Period; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology*
keywords: Hydronephrosis; Prenatal diagnosis; Renal function; Ureteropelvic junction obstruction; Urinary tract infection