Objective: We compared renal function before and after pyeloplasty in children with unilateral ureteropelvic junction obstruction (UPJO) according to the children's age. Methods: We reviewed the medical records of 36 children with UPJO who had undergone pyeloplasty and showed improved urine drainage on postoperative diuretic renal scan. The children were divided into two groups according to their age at the time of surgery: group I, ≤1 year of age (n = 15), and group II, >1 year of age (n = 21). Parenchymal thickness (PT) and pelvic anteroposterior diameter measured by ultrasonography and renal function measured by 99mTc-MAG3 renal scan were compared before and after surgery. Results: Group I patients, who underwent pyeloplasty within 1 year of birth, showed significant recovery of the PT ratio at follow-up evaluation (from 0.50 ± 0.13 preoperatively to 0.83 ± 0.23 postoperatively; p = 0.029) compared with that in group II (from 0.74 ± 0.23 preoperatively to 0.75 ± 0.18 postoperatively; NS). The mean differences in the PT ratio before and after surgery were 0.29 ± 0.25 and 0.02 ± 0.18 in groups I and II, respectively. Conclusion: This result suggests that early surgery improves subsequent parenchymal growth of the involved renal unit.

Keywords:
Ureteral obstruction, Pyeloplasty, Renal function
1.
Neste MG, du Cret RP, Finlay DE, et al: Postoperative diuresis renography and ultrasound in patients undergoing pyeloplasty. Predictors of surgical outcome. Clin Nucl Med 1993;18:872-876.
2.
Paduano L, Carini C, Alessandrini H: Validity of ultrasonography for postoperative monitoring in pediatric urology. J Urol 1996;155:1053-1056.
3.
Bernstein GT, Mandell J, Lebowitz RL, et al: Ureteropelvic junction obstruction in the neonate. J Urol 1988;140:1216-1221.
4.
Aliabadi H, Ami Sidi A, Gonzalez R: Management of ureteropelvic junction obstruction in infants and neonates. Eur Urol 1988;15:103-107.
5.
DiSandro MJ, Kogan BA: Neonatal management. Role for early intervention. Urol Clin North Am 1998;25:187-197.
6.
Reddy PP, Mandell J: Prenatal diagnosis. Therapeutic implications. Urol Clin North Am 1998;25:171-180.
7.
Koff SA: Neonatal management of unilateral hydronephrosis. Role for delayed intervention. Urol Clin North Am 1998;25:181-186.
8.
MacNeily AE, Maizels M, Kaplan WE, et al: Does early pyeloplasty really avert loss of renal function? A retrospective review. J Urol 1993;150:769-773.
9.
Raviv G, Leibovitch I, Shenfeld O, et al: Ureteropelvic junction obstruction: relation of etiology and age at surgical repair to clinical outcome. Urol Int 1994;52:135-139.
10.
Conway JJ: ‘Well-tempered' diuresis renography: its historical development, physiological and technical pitfalls, and standardized technique protocol. Semin Nucl Med 1992;22:74-84.
11.
Chandrasekharam VV, Srinivas M, Bal CS, et al: Functional outcome after pyeloplasty for unilateral symptomatic hydronephrosis. Pediatr Surg Int 2001;17:524-527.
12.
Roth DR, Gonzales ET Jr: Management of ureteropelvic junction obstruction in infants. J Urol 1983;129:108-110.
13.
Mayor G, Genton N, Torrado A, et al: Renal function in obstructive nephropathy: long-term effect of reconstructive surgery. Pediatrics 1975;56:740-747.
14.
Palmer LS, Maizels M, Cartwright PC, et al: Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol 1998;159:222-228.
15.
McAleer IM, Kaplan GW: Renal function before and after pyeloplasty: does it improve? J Urol 1999;162:1041-1044.
16.
Ortapamuk H, Naldoken S, Tekdogan UY, et al: Differential renal function in the prediction of recovery in adult obstructed kidneys after pyeloplasty. Ann Nucl Med 2003;17:663-668.
17.
Kinn AC, Bohman SO: Renal structural and functional changes after unilateral ureteral obstruction in rabbits. Scand J Urol Nephrol 1983;17:223-234.
18.
Parker RM, Rudd TG, Wonderly RK, et al: Ureteropelvic junction obstruction in infants and children: functional evaluation of the obstructed kidney preoperatively and postoperatively. J Urol 1981;126:509-512.
19.
King LR, Coughlin PW, Bloch EC, et al: The case for immediate pyeloplasty in the neonate with ureteropelvic junction obstruction. J Urol 1984;132:725-728.
20.
Conway JJ, Maizels M: The ‘well tempered' diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis. A report from 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;33:2047-2051.
21.
McCarthy CS, Sarkar SD, Izquierdo G, et al: Pitfalls and limitations of diuretic renography. Abdom Imaging 1994;19:78-81.
22.
Roarke MC, Sandler CM: Provocative imaging. Diuretic renography. Urol Clin North Am 1998;25:227-249.
23.
Song C, Park H, Park S, et al: The change in renal function in the supranormal hydronephrotic kidney after pyeloplasty. BJU Int 2007;99:1483-1486.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.