title: Functional and Morphological Outcomes of Pyeloplasty at Different Ages in Prenatally Diagnosed Society of Fetal Urology Grades 3-4 Ureteropelvic Junction Obstruction: Is It Safe to Wait?
abstract: OBJECTIVE
  To evaluate changes in functional and morphological outcomes in children with prenatally diagnosed Society of Fetal Urology (SFU) grades 3-4 ureteropelvic junction obstruction (UPJO) who underwent pyeloplasty at different ages. We also examined the effect of surgical wait time on recovery of renal function.
  
  
  METHODS
  All patients (aged 0-12 months) with prenatally diagnosed SFU grades 3-4 UPJO who underwent pyeloplasty in a single center between January 2013 and December 2015 were reviewed. One hundred thirty-three children were enrolled in this study. The children were divided into 2 groups according to their age at the time of surgery (group I: 0-3 months, group II: 3-12 months). We evaluated changes in parenchymal thickness, anteroposterior diameter (APD), and differential renal function (DRF) using ultrasound and diuretic renography. Functional and morphological outcomes were compared using Student t test.
  
  
  RESULTS
  A total of 133 patients were included in the study. We found a significant difference in the change of DRF (difference between before and after pyeloplasty) between the 2 groups (P < .05). There were no significant differences in changes in parenchymal thickness and APD. Patients who waited 1-2 months had a significantly lower functional improvement compared with those who waited less than 1 month.
  
  
  CONCLUSIONS
  Early surgery leads to a significant improvement in DRF. Wait times greater than 1 month can decrease functional improvement. For patients with prenatally diagnosed SFU grades 3-4 UPJO, early pyeloplasty is recommended in those with increasing renal pelvic APD and an obstructed renogram with differential renal function <40%.
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Dapeng
authors.initials: D
authors.lastname: Jiang
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Bingqiang
authors.initials: B
authors.lastname: Tang
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Maosheng
authors.initials: M
authors.lastname: Xu
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Houwei
authors.initials: H
authors.lastname: Lin
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Longhu
authors.initials: L
authors.lastname: Jin
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: He
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Guofeng
authors.initials: G
authors.lastname: Xu
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Xiaoliang
authors.initials: X
authors.lastname: Fang
authors.affiliation: Department of Pediatric Urology, Xinhua Hospital, National Key Clinical Specialty, Shanghai Top-Priority Clinical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: ghongquan@hotmail.com.
authors.forename: Hongquan
authors.initials: H
authors.lastname: Geng
mesh_terms: D004626:Embryology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D014517:Ureteral Obstruction / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014572:Urology