Postnatal unilateral pelviureteral junction obstruction: impact of pyeloplasty and conservative management on renal function

Ahmed A Shokeir, Mohamed T El-Sherbiny, Hosam M Gad, Mohamed Dawaba, Ashraf T Hafez, Mohamed A Taha, Mohamed Saida, Ahmed M Ghaly
Urology 2005, 65 (5): 980-5; discussion 985

OBJECTIVES: 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.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"