Skip to main content
Log in

Is it Always Necessary to Treat an Asymptomatic Hydronephrosis Due to Ureteropelvic Junction Obstruction?

  • Review Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The postnatal treatment of asymptomatic unilateral hydronephrosis due to ureteropelvic junction obstruction remains controversial, and the timing of and indications for surgical intervention are continuously debated. There is no consensus on the best follow-up during expectant management. The various modalities and parameters have been discussed along with their pros and cons and an attempt has been made to clear up the controversies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. King L, Coughlin P, Bloch EC, Bowie JD, Ansong K, Hanna MK. The case for immediate pyeloplasty in the neonate with ureteropelvic junction obstruction. J Urol. 1984;132:725–8.

    CAS  PubMed  Google Scholar 

  2. Koff SA, Campbell KD. The nonoperative management of unilateral neonatal hydronephrosis: natural history of poorly functioning kidneys. J Urol. 1994;152:593–5.

    CAS  PubMed  Google Scholar 

  3. Ulman I, Jayanthi VR, Koff SA. The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol. 2000;164:1101–5.

    Article  CAS  PubMed  Google Scholar 

  4. Chertin B, Pollack A, Koulikov D, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol. 2006;49:734–8.

    Article  PubMed  Google Scholar 

  5. Onen A. Treatment and outcome of prenatally detected newborn hydronephrosis. J Pediatr Urol. 2007;3:469–76.

    Article  PubMed  Google Scholar 

  6. Dhillon HK. Prenatally diagnosed hydronephrosis: the great Ormond street experience. Br J Urol. 1998;81:39–44.

    Article  PubMed  Google Scholar 

  7. Onen A. An alternative grading system to refine the criteria for severity of hydronephrosis and optimal treatment guidelines in neonates with primary UPJ-type hydronephrosis. J Pediatr Urol. 2007;3:200–5.

    Article  PubMed  Google Scholar 

  8. Thorup J, Mortensen T, Diemer H, Johnsen A, Nielsen OH. The prognosis of surgically treated congenital hydronephrosis after diagnosis in utero. J Urol. 1985;134:914–7.

    CAS  PubMed  Google Scholar 

  9. Cartwright PC, Duckett JW, Keating MA, et al. Managing apparent ureteropelvic junction obstruction in the newborn. J Urol. 1992;148:1224–8.

    CAS  PubMed  Google Scholar 

  10. Ylinen E, Ala-Houhala M, Wikström S. Outcome of patients with antenatally detected pelviureteric junction obstruction. Pediatr Nephrol. 2004;19:880–7.

    PubMed  Google Scholar 

  11. Wollenberg A, Neuhaus TJ, Willi UV, Wisser J. Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol. 2005;25:483–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hashim H, Woodhouse CRJ. Ureteropelvic junction obstruction. Eur Urol Suppl. 2012;11:S25–32.

    Article  Google Scholar 

  13. Pates JA, Dashe JS. Prenatal diagnosis and management of hydronephrosis. Early Hum Dev. 2006;82:3–8.

    Article  PubMed  Google Scholar 

  14. Nguyen HT, Herndon CD, Cooper C, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6:212–31.

    Article  PubMed  Google Scholar 

  15. Subramaniam R, Kouriefs C, Dickson AP. Antenatally detected pelvi-ureteric junction obstruction: concerns about conservative management. BJU Int. 1999;84:335–8.

    Article  CAS  PubMed  Google Scholar 

  16. Arora S, Yadav P, Kumar M, et al. Predictors for the need of surgery in antenatally detected hydronephrosis due to UPJ obstruction--a prospective multivariate analysis. J Pediatr Urol. 2015;11:248.e1–5.

    Article  CAS  Google Scholar 

  17. Eskild-Jensen A, Munch Jørgensen T, Olsen LH, Djurhuus JC, Frøkiaer J. Renal function may not be restored when using decreasing differential function as the criterion for surgery in unilateral hydronephrosis. BJU Int. 2003;92:779–82.

    Article  CAS  PubMed  Google Scholar 

  18. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993;23:478–80.

    Article  CAS  PubMed  Google Scholar 

  19. Keays MA, Guerra LA, Mihill J, et al. Reliability assessment of Society for Fetal Urology ultrasound grading system for hydronephrosis. J Urol. 2008;180:1680–2.

    Article  CAS  PubMed  Google Scholar 

  20. Cost GA, Merguerian PA, Cheerasarn SP, Shortliffe LM. Sonographic renal parenchymal and pelvicaliceal areas: new quantitative parameters for renal sonographic followup. J Urol. 1996;156:725–9.

  21. Imaji R, Dewan PA. Calyx to parenchyma ratio in pelvi-ureteric junction obstruction. BJU Int. 2002;89:73–7.

    Article  CAS  PubMed  Google Scholar 

  22. Shapiro SR, Wahl EF, Silberstein MJ, Steinhardt G. Hydronephrosis index: a new method to track patients with hydronephrosis quantitatively. Urology. 2008;72:536–8.

    Article  PubMed  Google Scholar 

  23. Babu R, Sai V. Pelvis/cortex ratio: a sonographic marker of pelviureteric junction obstruction in children. Indian J Urol. 2010;26:494–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mudrik-Zohar H, Meizner I, Bar-Sever Z, Ben-Meir D, Davidovits M. Prenatal sonographic predictors of postnatal pyeloplasty in fetuses with isolated hydronephrosis. Prenat Diagn. 2015;35:142–7.

    Article  PubMed  Google Scholar 

  25. Chipde SS, Lal H, Gambhir S, et al. Factors predicting improvement of renal function after pyeloplasty in pediatric patients: a prospective study. J Urol. 2012;188:262–5.

    Article  PubMed  Google Scholar 

  26. O’Reilly PH, Testa HJ, Lawson RS, Farrar DJ, Charlton EE. Diuresis renography in equivocal urinary tract obstruction. Br J Urol. 1978;50:76–80.

    Article  PubMed  Google Scholar 

  27. O'Reilly PH; Consensus Committee of the Society of Radionuclides in Nephrourology. Standardization of the renogram technique for investigating the dilated upper urinary tract and assessing the results of surgery. BJU Int. 2003;91:239–43.

  28. Ransley P, Manzoni G. Extended role of DTPA scan in assessing function and UPJ obstruction in neonate. Dial Ped Urol. 1985;8:6–8.

    Google Scholar 

  29. 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;33:2047–51.

    CAS  PubMed  Google Scholar 

  30. Gordon I, Piepsz A, Sixt R. Guidelines for standard and diuretic renogram in children. Eur J Nucl Med Mol Imaging. 2011;38:1175–88.

    Article  PubMed  Google Scholar 

  31. Taghavi R, Ariana K, Arab D. Diuresis renography for differentiation of upper urinary tract dilatation from obstruction: F+20 and F-15 methods. Urol J. 2007;4:36–40.

    PubMed  Google Scholar 

  32. Ueno S, Suzuki Y, Murakami T, et al. Quantitative analysis of infantile ureteropelvic junction obstruction by diuretic renography. Ann Nucl Med. 2001;15:131–6.

    Article  CAS  PubMed  Google Scholar 

  33. Ross SS, Kardos S, Krill A, et al. Observation of infants with SFU grades 3-4 hydronephrosis: worsening drainage with serial diuresis renography indicates surgical intervention and helps prevent loss of renal function. J Pediatr Urol. 2011;7:266–71.

    Article  PubMed  Google Scholar 

  34. Rossleigh MA, Thomas MY, Moase AL. Determination of the normal range of furosemide half-clearance times when using Tc-99m MAG3. Clin Nucl Med. 1994;19:880–2.

    Article  CAS  PubMed  Google Scholar 

  35. Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. J Urol. 1990;144:584–7.

    CAS  PubMed  Google Scholar 

  36. Hafez AT, McLorie G, Bagli D, Khoury A. Analysis of trends on serial ultrasound for high grade neonatal hydronephrosis. J Urol. 2002;168:1518–21.

    Article  PubMed  Google Scholar 

  37. Piepsz A, Hall M, Ham HR, Verboven M, Collier F. Prospective management of neonates with pelviureteric junction stenosis. Therapeutic strategy based on 99m Tc-DPTA studies. Scand J Urol Nephrol. 1989;23:31–6.

    Article  CAS  PubMed  Google Scholar 

  38. Duong HP, Piepsz A, Collier F, et al. Predicting the clinical outcome of antenatally detected unilateral pelviureteric junction stenosis. Urology. 2013;82:691–6.

    Article  PubMed  Google Scholar 

  39. Karnak I, Woo LL, Shah SN, Sirajuddin A, Ross JH. Results of a practical protocol for management of prenatally detected hydronephrosis due to ureteropelvic junction obstruction. Pediatr Surg Int. 2009;25:61–7.

    Article  PubMed  Google Scholar 

  40. Stock JA, Krous HF, Heffernan J, Packer M, Kaplan GW. Correlation of renal biopsy and radionuclide renal scan differential function in patients with unilateral ureteropelvic junction obstruction. J Urol. 1995;154:716–8.

    Article  CAS  PubMed  Google Scholar 

  41. Chiou YY, Chiu NT, Wang ST, Cheng HL, Tang MJ. Factors associated with the outcomes of children with unilateral ureteropelvic junction obstruction. J Urol. 2004;171:397–402.

    Article  PubMed  Google Scholar 

  42. Nguyen HT, Gluckman GR, Kogan BA. Changing the technique of background subtraction alters calculated renal function on pediatric mercaptoacetyltriglycine renography. J Urol. 1997;158:1252–6.

    Article  CAS  PubMed  Google Scholar 

  43. Boubaker A, Meyrat B, Frey P, Bischof DA. Unilateral urinary flow impairment at the pelviureteral junction: outcome of renal function with respect to therapeutic strategy. Urology. 2003;61:1224–8.

    Article  PubMed  Google Scholar 

  44. Chertin B, Rolle U, Farkas A, Puri P. Does delaying pyeloplasty affect renal function in children with a prenatal diagnosis of pelvi-ureteric junction obstruction? BJU Int. 2002;90:72–5.

    Article  CAS  PubMed  Google Scholar 

  45. Palmer LS, Maizels M, Cartwright PC, Fernbach SK, Conway JJ. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. J Urol. 1998;159:222–8.

    Article  CAS  PubMed  Google Scholar 

  46. Wåhlin N, Magnusson A, Persson AE, Läckgren G, Stenberg A. Pressure flow measurement of hydronephrosis in children: a new approach to definition and quantification of obstruction. J Urol. 2001;166:1842–7.

    Article  PubMed  Google Scholar 

  47. McMann LP, Kirsch AJ, Scherz HC, et al. Magnetic resonance urography in the evaluation of prenatally diagnosed hydronephrosis and renal dysgenesis. J Urol. 2006;176:1786–92.

    Article  PubMed  Google Scholar 

  48. Kessler RM, Quevedo H, Lankau CA, et al. Obstructive vs nonobstructive dilatation of the renal collecting system in children: distinction with duplex sonography. AJR Am J Roentgenol. 1993;160:353–7.

  49. Okada T, Yoshida H, Iwai J, et al. Pulsed Doppler sonography of the hilar renal artery: differentiation of obstructive from nonobstructive hydronephrosis in children. J Pediatr Surg. 2001;36:416–20.

    Article  CAS  PubMed  Google Scholar 

  50. Bajpai M, Bal CS, Tripathi M, Kalaivani M, Gupta AK. Prenatally diagnosed unilateral hydronephrosis: prognostic significance of plasma renin activity. J Urol. 2007;178:2580–4.

    Article  PubMed  Google Scholar 

  51. Decramer S, Bascands JL, Schanstra JP. Non-invasive markers of ureteropelvic junction obstruction. World J Urol. 2007;25:457–65.

    Article  PubMed  Google Scholar 

  52. Gatti JM, Broecker BH, Scherz HC, Perez-Brayfield MR, Kirsch AJ. Antenatal hydronephrosis with postnatal resolution: how long are postnatal studies warranted? Urology. 2001;57:1178.

    Article  CAS  Google Scholar 

  53. Song SH, Lee SB, Park YS, Kim KS. Is antibiotic prophylaxis necessary in infants with obstructive hydronephrosis? J Urol. 2007;177:1098–101.

    Article  PubMed  Google Scholar 

  54. Madden NP, Thomas DF, Gordon AC, Arthur RJ, Irving HC, Smith SE. Antenatally detected pelviureteric junction obstruction. Is non-operation safe? Br J Urol. 1991;68:305–10.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yogesh Kumar Sarin.

Ethics declarations

Conflict of Interest

None.

Source of Funding

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sarin, Y.K. Is it Always Necessary to Treat an Asymptomatic Hydronephrosis Due to Ureteropelvic Junction Obstruction?. Indian J Pediatr 84, 531–539 (2017). https://doi.org/10.1007/s12098-017-2346-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-017-2346-9

Keywords

Navigation