Long term outcome of management of antenatally diagnosed pelvi-ureteric junction obstruction.

Objective: To evaluate the outcome of children with antenatally detected unilateral pelvi-ureteric junction obstruction (PUJO).

Methods: Children with antenatally diagnosed hydronephrosis, postnatally, unequivocally proven to be due to PUJO, with a normal contralateral kidney were evaluated. Children with atleast 2 y of follow-up were included in the study. The children were divided into early pyeloplasty (those who underwent pyeloplasty at presentation) and conservative (who were managed conservatively). Children in conservative group, who required pyeloplasty during follow up, constituted the delayed pyeloplasty group and those who are still being managed conservatively constituted the no surgery group. The outcome was compared in between these groups in terms of relative function of the affected kidney, drainage pattern and pelvicalyceal dilatation.

Results: A total of 30 children with a mean follow up of 43.3 mon were enrolled in the study. Of the 30 patients, ten had undergone early pyeloplasty and the remaining 20 were managed conservatively. Of these 20, 8 had undergone delayed pyeloplasty and the remaining 12 constituted no surgery group. Overall, 40% of patients in the present study had not required pyeloplasty till the end of the study period. The renal function in early pyeloplasty and conservative group was maintained or improved. Delayed pyeloplasty was able to restore the function in those operated for fall in function to the level that was seen at presentation. The change in renal function in between the early and delayed pyeloplasty groups was not statistically significant (p 0.97).

Conclusions: The conservative management of PUJO, in renal unit with good function, does not lead to any significant deterioration in the function even when delayed pyeloplasty is performed, when indicated. Two-fifths of the patients may not require pyeloplasty at all.