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Functional results of pyeloplasty in patients with ante-natally diagnosed pelvi-ureteric junction obstruction Cornford PA; Rickwood AMBr J Urol 1998[Jan]; 81 (1): 152-5OBJECTIVE: To assess the outcome after pyeloplasty in children with an ante-natal diagnosis of hydronephrosis, shown on post-natal renography to be due to pelvi-ureteric junction (PUJ) obstruction, and in particular to review the outcome of those who had initially been managed expectantly. PATIENTS AND METHODS: Between 1984 and 1995, 321 patients were diagnosed as having PUJ obstruction, after investigating ante-natal hydronephrosis. Of these, 47 had undergone pyeloplasty and also had a normal contralateral kidney; 26 patients had early pyeloplasty because of impaired function and 21 underwent surgery after a period of expectant management. Renal function was assessed renographically before and at least one year after surgery. RESULTS: Relative renal function was stabilized in those patients who underwent early pyeloplasty (mean differential function 28.1% before and 32.7% after surgery). In patients who underwent pyeloplasty after a period of expectant management, the mean relative function decreased from 44.8% initially to 30.5% before surgery; this recovered to 37.5% at the post-operative reassessment, representing a statistically significant loss of function (P < 0.01). CONCLUSION: In patients born with PUJ obstruction and impaired renal function, pyeloplasty failed to significantly improve function. Possibly because of cortical loss. In patients with ante-natal PUJ obstruction managed expectantly there is a small but significant risk of a modest loss of renal function.|Child[MESH]|Child, Preschool[MESH]|Humans[MESH]|Hydronephrosis/congenital/diagnosis/physiopathology/*surgery[MESH]|Infant[MESH]|Kidney Pelvis/surgery[MESH]|Postoperative Care[MESH]|Prenatal Diagnosis[MESH]|Ureteral Obstruction/complications/physiopathology/*surgery[MESH] |
