Management of neonatal ureteropelvic junction obstruction

Transpelvic anastomotic stenting: a good option for diversion after pyeloplasty in children

PURPOSE

Several options are available to drain the renal pelvis after a dysmembered pyeloplasty. The purpose of our study was to review the results of transrenal pelvic transanastomotic stenting following ureteropelvic junction obstruction pyeloplasty (UPJO).

PATIENTS AND METHODS

A retrospective chart review of 238 patients with UPJO (243 renal units) treated in 2004-2007. The patients were divided into 4 groups (1): renal units with very poor function (<10% uptake) having undergone nephrostomy tube placement, with pyeloplasty performed 1 month later for those with improved renal function, and nephrectomy for those with no improvement (2); pyeloplasty without diversion (3); pyeloplasty diverted with transrenal pelvis transanastomotic stenting (4); pyeloplasties diverted with both stents and Foley catheters; the stents used were 5 Fr or 6 Fr feeding tubes.

RESULTS

Group 1: 13 nephrectomies and 31 pyeloplasties diverted with stents and Foley catheters; 1/31 re-do pyeloplasty. Group 2: 33 pyeloplasties that were performed without diversion or stenting; 2/33 required re-do pyeloplasty. Group 3: 122 pyeloplasties diverted with only stents inserted through renal pelvis with 1 nephrostomy due to urine leakage, 2 prolonged urine leaks that ceased spontaneously, 1 urinary infection, no re-do pyeloplasty needed. Group 4: 44 pyeloplasties that were performed with stents and nephrostomy tubes, 2 delays of removal of Foley catheters, no re-do pyeloplasty needed.

CONCLUSIONS

Transrenal pelvis transanastomotic stenting using a feeding tube is a good option for diverting urine following dysmembered pyeloplasty in children.

Antenatal hydronephrosis: evaluation and outcome

We present a comprehensive and current review of the etiology, evaluation, treatment, and outcome of antenatal hydronephrosis. When a diagnosis of antenatal hydronephrosis is made, many questions regarding pregnancy, prenatal care, intervention, and what may be expected after birth are raised. Debate and controversy exist on the diagnosis and subsequent evaluation and management of the child with antenatal hydronephrosis. A review of the literature and our own experience with antenatal hydronephrosis are presented in order to guide the physician who is caring for mother and child.