Apparent Unilateral Ureteropelvic Junction Obstruction in the Newborn: Expectations for Resolution

No AccessJournal of UrologyPediatric Urology1 Dec 1998APPARENT UNILATERAL URETEROPELVIC JUNCTION OBSTRUCTION IN THE NEWBORN: EXPECTATIONS FOR RESOLUTION NORA V. TAKLA, BLAKE D. HAMILTON, PATRICK C. CARTWRIGHT, and BRENT W. SNOW NORA V. TAKLANORA V. TAKLA More articles by this author , BLAKE D. HAMILTONBLAKE D. HAMILTON More articles by this author , PATRICK C. CARTWRIGHTPATRICK C. CARTWRIGHT More articles by this author , and BRENT W. SNOWBRENT W. SNOW More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)62287-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We retrospectively reviewed the records of patients with prenatal hydronephrosis to characterize those in whom it was more likely to resolve with conservative management. Materials and Methods: We studied 51 patients in a 4-year period who presented with nonspecific unilateral hydronephrosis diagnosed by prenatal and confirmed by postnatal sonography. Patients were followed with sequential nuclear renograms with furosemide washout to evaluate function and drainage. In all cases a nonoperative approach was attempted. Pyeloplasty was performed only for poor or decreasing kidney function and/or drainage. Results: Four of the 51 patients were lost to followup, 21 of the remaining 47 (45%) eventually underwent surgery, and 26 (55%) had complete normalization of renal function and washout pattern without surgery. There was no statistically significant correlation between hydronephrosis grade on initial postnatal sonography and the likelihood of nonsurgical resolution. However, the shape of the washout curve on nuclear renography was informative for predicting outcome, since 86% of the cases with a nonobstructive drainage pattern normalized without surgery, while 62% with indeterminate and only 18% with obstructive curves resolved with conservative management (p <0.01). Notably in 83% of the cases of normalization without surgery resolution occurred before age 18 months. Also, an initial obstructed washout pattern was more likely to be associated with a poor outcome. Of the 6 patients with less than 40% final differential function 5 had an obstructed washout pattern on the initial nuclear renogram. Conclusions: Patients diagnosed by prenatal ultrasound with apparent unilateral ureteropelvic junction obstruction generally do well with conservative treatment. However, those who present with an obstructed washout pattern are less likely to have resolution without surgery and more likely to have poor final differential function. References 1 : Ureteropelvic junction obstruction in the neonate. J. Urol.1988; 140: 1216. Link, Google Scholar 2 : The case for immediate pyeloplasty in the neonate with ureteropelvic junction obstruction. J. Urol.1984; 132: 725. Link, Google Scholar 3 : The case for the relief of ureteral pelvic junction obstruction in neonates and young children at time of diagnosis. Urology1991; 38: 195. Google Scholar 4 : The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J. Urol.1990; 144: 584. Link, Google Scholar 5 : The nonoperative management of unilateral neonatal hydronephrosis: natural history of poorly functioning kidneys. J. Urol.1994; 152: 593. Link, Google Scholar 6 : Transitional hydronephrosis of the newborn and infant. J. Urol.1990; 144: 579. Link, Google Scholar 7 : Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Ped. Rad.1993; 23: 478. Crossref, Medline, Google Scholar 8 : The “well-tempered” diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis. A report from the combined meetings of The Society for Fetal Urology and members of The Pediatric Nuclear Medicine Council-The Society of Nuclear Medicine. J. Nucl. Med.1992; 33: 2047. Google Scholar 9 : Prenatal diagnosis of urinary tract abnormalities by ultrasound. Pediatrics1986; 78: 879. Crossref, Medline, Google Scholar 10 : Antenatal diagnosis of congenital abnormalities in the urinary tract. Results from the Northern Region Fetal Abnormality Survey. Brit. J. Urol.1988; 62: 295. Google Scholar 11 : The fate of infant kidneys with fetal hydronephrosis but initially normal postnatal sonography. J. Urol., part 21989; 142: 661. Abstract, Google Scholar 12 : Renal function in obstructive nephropathy: long-term effect of reconstructive surgery. Pediatrics1975; 56: 740. Google Scholar 13 : Outcome analysis of pediatric pyeloplasty as a function of patient age, presentation and differential renal function. J. Urol.1995; 154: 1889. Link, Google Scholar 14 : Delayed management of neonatal hydronephrosis. J. Urol.1988; 140: 1305. Link, Google Scholar 15 : Does early pyeloplasty really avert loss of renal function? A retrospective review. J. Urol.1993; 150: 769. Google Scholar 16 : Managing apparent ureteral pelvic junction obstruction in the newborn. J. Urol.1992; 148: 1224. Link, Google Scholar From the Division of Urology, Department of Surgery, University of Utah Hospitals and Primary Children's Medical Center, Salt Lake City, Utah© 1998 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byBraga L, McGrath M, Farrokhyar F, Jegatheeswaran K and Lorenzo A (2017) Society for Fetal Urology Classification vs Urinary Tract Dilation Grading System for Prognostication in Prenatal Hydronephrosis: A Time to Resolution AnalysisJournal of Urology, VOL. 199, NO. 6, (1615-1621), Online publication date: 1-Jun-2018.Braga L, McGrath M, Farrokhyar F, Jegatheeswaran K and Lorenzo A (2016) Associations of Initial Society for Fetal Urology Grades and Urinary Tract Dilatation Risk Groups with Clinical Outcomes in Patients with Isolated Prenatal HydronephrosisJournal of Urology, VOL. 197, NO. 3 Part 2, (831-837), Online publication date: 1-Mar-2017.Kim D, Mickelson J, Helfand B, Maizels M, Kaplan W and Yerkes E (2009) Fetal Pyelectasis as Predictor of Decreased Differential Renal FunctionJournal of Urology, VOL. 182, NO. 4S, (1849-1853), Online publication date: 1-Oct-2009.Rosen S, Peters C, Chevalier R and Huang W (2008) The Kidney in Congenital Ureteropelvic Junction Obstruction: A Spectrum From Normal to NephrectomyJournal of Urology, VOL. 179, NO. 4, (1257-1263), Online publication date: 1-Apr-2008.Bajpai M, Bal C, Tripathi M, Kalaivani M and Gupta A (2007) Prenatally Diagnosed Unilateral Hydronephrosis: Prognostic Significance of Plasma Renin ActivityJournal of Urology, VOL. 178, NO. 6, (2580-2584), Online publication date: 1-Dec-2007.ESKILD-JENSEN A, GORDON I, PIEPSZ A and FRØKIÆR J (2018) CONGENITAL UNILATERAL HYDRONEPHROSIS: A REVIEW OF THE IMPACT OF DIURETIC RENOGRAPHY ON CLINICAL TREATMENTJournal of Urology, VOL. 173, NO. 5, (1471-1476), Online publication date: 1-May-2005.ITANO N, SHERRILL L, LERMAN L, CORICA F, HAUSER M, ROMERO J and HUSMANN D (2018) ELECTRON BEAM COMPUTERIZED TOMOGRAPHY ASSESSMENT OF IN VIVO SINGLE KIDNEY GLOMERULAR FILTRATION RATE AND TUBULAR DYNAMICS DURING CHRONIC PARTIAL UNILATERAL URETERAL OBSTRUCTION IN THE PIGJournal of Urology, VOL. 166, NO. 6, (2530-2535), Online publication date: 1-Dec-2001.ULMAN I, JAYANTHI V and KOFF S (2018) THE LONG-TERM FOLLOWUP OF NEWBORNS WITH SEVERE UNILATERAL HYDRONEPHROSIS INITIALLY TREATED NONOPERATIVELYJournal of Urology, VOL. 164, NO. 3 Part 2, (1101-1105), Online publication date: 1-Sep-2000.ESKILD-JENSEN A, CHRISTENSEN H, LINDVIG M, FRøKIæR J, REHLING M, JøRGENSEN H, DJURHUUS J and JøRGENSEN T (2018) RENAL FUNCTIONAL OUTCOME IN UNILATERAL HYDRONEPHROSIS IN NEWBORN PIGSJournal of Urology, VOL. 163, NO. 6, (1896-1900), Online publication date: 1-Jun-2000. Volume 160Issue 6 Part 1December 1998Page: 2175-2178 Advertisement Copyright & Permissions© 1998 by American Urological Association, Inc.Metrics Author Information NORA V. TAKLA More articles by this author BLAKE D. HAMILTON More articles by this author PATRICK C. CARTWRIGHT More articles by this author BRENT W. SNOW More articles by this author Expand All Advertisement PDF downloadLoading ...