Assessment of the Clinical Outcome of Management of Prenatally Detected Severe Bilateral Ureteric-Pelvic Junction Obstruction
Keywords:
Clinical, Outcome, Management, Prenatal, Severe, Bilateral, Ureteric-Pelvic Junction ObstructionAbstract
Background: Hydronephrosis is the most frequently encountered genitourinary issue during prenatal ultrasounds. Antenatal and neonatal hydronephrosis are predominantly caused by ureteric-pelvic junction obstruction (UPJO). Our purpose was to evaluate the clinical prognosis of the severe bilateral UPJO management that was prenatally detected.
Methods: This retrospective study analyzed the records of patients diagnosed with bilateral hydronephrosis, grades 3–4, which subsequently led to the severe UPJO diagnosis on postnatal ultrasonography. All patients underwent voiding cystourethrography (VCUG) during the perinatal period. Ultrasonography was repeated within 4 weeks of birth.
Results: 11 patients out of the 34 patients referred with antenatal bilateral hydronephrosis (5.98%) with grade 3–4 hydronephrosis. Two patients (18.18%) had hydronephrosis with complications; they underwent bilateral percutaneous nephrostomies. A total of four patients (36.36%) were diagnosed with bilateral grade 4 hydronephrosis and underwent unilateral open pyeloplasty with contralateral stenting. The number of patients with unilateral grade 4 hydronephrosis and contralateral grade 3 hydronephrosis was five (45.45%). Four of the five patients demonstrated an improvement in their hydronephrosis on ultrasonography and a favourable drainage pattern on a renal scan, while one patient had deteriorated and underwent late pyeloplasty on a worsening renal unit with a significant decrease in relative renal function (RRF).
Conclusions: In neonates presenting with bilateral UPJO, consecutive bilateral pyeloplasty was an effective approach for such cases, which found hydronephrosis improvement on ultrasonography and a good drainage pattern on the 99mTc-MAG3 renal scan.
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