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Year : 2016  |  Volume : 8  |  Issue : 6  |  Page : 102-108  

Ureteropelvic junction obstruction

Date of Web Publication26-Apr-2016

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How to cite this article:
. Ureteropelvic junction obstruction. Urol Ann 2016;8, Suppl S2:102-8

How to cite this URL:
. Ureteropelvic junction obstruction. Urol Ann [serial online] 2016 [cited 2020 Jul 12];8, Suppl S2:102-8. Available from: http://www.urologyannals.com/text.asp?2016/8/6/102/181198

Ureteropelvic junction obstruction in paediatrics

Faris M. Ayyat, M. Al Jishi

Department of Urology, Dhahran Health Centre, Dhahran, Saudi Arabia

UPJ is a common site of urinary tract obstruction in infants and children. Fourteen paediatric cases of UPJ obstruction were reviewed in Dhahran Health Centre from the medical records between 1982 and 1989. A follow up range between 3 months and 86 months; a mean follow up of 44 months, i.e., 3.7 years. There were 10 males and 4 females, a ratio of 2.5:1. The disease was bilateral in 6 patients, i.e., 43%. Eight patients were under 3 months of age and 6 patients, were between 2 years and 8 years, and with a right to left ratio of 1:1. The methods of diagnosis included 2 cases by antenatal sonography, another 4 by abdominal sonography and 8 by urography. Seventeen renal units were operated, 16 by dismembered pyeloplasty, and one underwent nephrectomy. No mortality in this series. Two patients had complications. One, a drain was lost in the abdomen and another developed infection calculi in the operated kidney 2 years after surgery and he had a deteriorating renal function in that single kidney. This patient had ectopia vesicae and a contralateral blind ending refluxing ureter. Post-operative diuresis carries a good prognosis for renal function recovery. We have found that dismembered pyeloplasty is suitable for the vast majority of patients. A voiding cystoureterogram should be obtained in paediatric cases to rule out reflux.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Antenatal detection of obstructive uropathy

M. H. Baqai, A. Khurdi, M. S. Abomelha, K. Al Otaibi, M. A. Kourah

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

In children, early diagnosis and management of obstructive uropathy is essential to preserve the functioning nephrons especially in neonates and infants where the immature nephrons are more susceptible to pressure. Fetal hydronephrosis can be diagnosed antenatally by ultrasound and thereby helps the early management.

Between January 1987 and May 1990 at RAFH, 53 cases of fetal hydronephrosis were detected during routine antenatal screening (PUJ, posterior urethral valves, reflux and neurogenic bladder). The incidence was 1 in 340 live births. All but one were allowed to proceed to full term and followed postnatally. 10 cases were found to have normal upper tract on postnatal ultrasound examination. 16 were mild dilatation of the upper tract were followed with ultrasound and found to have resolved without active surgical intervention. 26 neonates had moderate to severe dilatation of the upper tract supported by other investigations and IVU, MCU and DTPA renogram as appropriate and needed surgical correction. Serum creatinine and creatinine clearance the main criteria of renal function. One case of gross hydronephrosis and pressure effect on other organs was drained in utero.

In our experience we found that the antenatal ultrasound screening with postnatal follow up was the most helpful non-invasive investigation and creatinine clearance was responsible for the decision of surgical correction at an early stage.

Presented at the: 6 th Saudi Urological Conference

National Guard King Khalid Hospital - Jeddah

27-28 November 1991

Uretero-pelvic junctions obstruction in paediatrics

F. M. Ayyat

Saudi Aramco Surgical Services Division, Dhahran Health Center, Dhahran, Saudi Arabia

35 paediatrics cases of UPJ dysfunction were managed at Dhahran Health Center (1982-1992), a mean follow up of 6 years. The disease was bilateral in 28%. 28 patients were under 3 months and 7 were (2-11 years). Ante and postnatal sonography were diagnostic of the problem. 29 renal units were operated, majority 27 by dismembered pyeloplasty. 3 patients had complication but none of them needed post-nephrectomy or reconstruction. 24 had nephrostomy tube and 5 of them had ureteral stents. 10 patients were followed conservatively by ultrasound.

Conclusion: Neonatal pyeloplasty is a safe procedure when it is indicated. None of the patients had deteriorating renal function. Not every hydronephrosis is a surgery indication. Nephrostomy tube is still controversial.

Presented at the: 7 th Saudi Urological Conference

Riyadh Armed Forces Hospital

11-12 November 1992

Outcome of neonates with puj-obstruction detected antenatally

M. S. Abomelha, M. T. Said, A. Al Ghamdi, S. A. Orkubi, A. A. Shaaban

Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Over a period of nine years (1987-1995), we have treated and followed up 103 neonates with antenatally detected renal anomalies. As expected. PUJ obstruction is the most common antenatally detected renal anomaly which was present in 52% of these neonates. There were 56 neonates with 77 renal units involved. Five patients with 8 renal units were lost for follow up. 51 neonates with 69 renal units were followed up with a mean follow up period of 35 months (range 6-104 months). Only 16 renal units needed pyeloplasty, one neonate had nephrectomy for non-functioning kidney, while the rest 52 units (75%) had only close observation.

The outcome of the closed observation group showed improvement in 35% resolution in 48% and no change in 17% No cases of deterioration were observed. It is concluded that the majority of antenatally detected anomalies were PUJ obstruction. The majority of antenatally detected PUJ obstruction was not in need of surgical correction. Close observation was the method of choice in 75% of cases.

Presented at the: 11 th Saudi Urology Conference

King Fahd Military Medical Complex - Dhahran

24-26 February 1998 (27-29 Shawwal 1418)

Diuretic renography in the diagnosis and follow up of pujdiagnosed pre-natally

E. Roboei, M. Notarantonio, S. L. Jacob

Department of Pediatric Surgery, Hospital Necker Des Enfantes Malades, Paris, France, Department of Urology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

Due to wide spread use of obstetrical ultrasonography with fetal screening, congenital uropathies are usually diagnose in asymptomatic neonates. The main issues is to distinguish those cases of dilation, which are clearly obstructive and need surgical management from those who are within the normal anatomical range. The examination of the three parameters of the nuclear scan (type of curve, clearance half time and differential renal function) provides an objective measure of the condition of the affected renal unit and in majority of patients can reliably diagnose or exclude obstruction. For recognizing this value of diuretic renography advocated by O'Reilly and modified by Koff, a retrospective study was carried out on 144 neonates diagnosed prenatally to have PUJ obstruction at Necker Des Enfantes Malades a Paris from 1986 to 1993.

All neonates were evaluated with ultrasonography, voiding cystogram in 115 patients; ultrasonography and IVP in 122 patients; percutaneous pre-op nephrostomies in 7 patients and 3 of them have had nephrectomies. Diuresis renography has been the most important test inducing us to adopt the operative or conservative treatment in 83 PUJ, renal function was from 0% - 19% in 5 patients and above 40% in 70 patients; these are the subject of our study; nephrectomies was done in 4 neonates. Primary and secondary pyeloplasties were carried out on 42 patients (Group B) based on the initial report of renography and 40 patients were treated conservatively (Group A). Those compared with 23 PUJ operated on without renography (Group C). According to pre-op IVP results, 18 with grade 3, 4 grade 3+ and 1 grade 2 hydronephrosis.

Median age for pyeloplasty was 2.5 months. Ultrasonography was performed on all patients in the follow up period and decreased dilation was considered as a good result. Diuretic renogram was done on 21 operated patients and 13 non-operated patients. Total of 100 patients and 106 PUJ study. The follow up period of time ranged between 1-6 years.


Group A There were three cases with type II who needed secondary pyeloplasties, eight cases of normal type I, three patients with type IIIa and zero type IIIb.

Group B There were nine case type I, eight type IIIa and two cases with type IIIb, Although 21 patients showed an improvement in renal function on past-oprenogram, one renal function deterioration was noticed in the series (from 30% Ϳto 25). One patient had pyelonephritis without any V-U reflux 1-year postoperative.

Group C Postoperative renography (DMSA)15 has function 40-50%, 5 has 30-40 2 between 20-29% and 1 has less than 10% function. Two cases were reoperated on because of stricture and stone formation 3 months postoperative in one and 5 years later in the other patient because of sign and symptoms of persistent obstruction.

Conclusions: Percutaneous nephrostomy in neonates still could be the first line of treatment in severely hydronephrotic kidney (7/83 patients in this series). Diuresis renogram is more clinically useful test and it has the added advantage of being non-invasive. A prospective stud should be carried out later on to identify the usefulness of diaries renogram in following up the PUJ obstruction. One patient at least could have been saved from 2 operations in Group C. Neonatal pyeloplasty is safe and carries minimal complications.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospital Program

23-25 February 1999 (7-9 Dhu Al Qa'dah 1419)

Biology of ftal glomerulocystic disease associated with urteric obstruction

R. Attar, F. Quinn, A. S. Woolf

Department of Urology, Nephrourology Unit, Institute of Child Health, Great Osmond Street Hospital, London, UK, Department of Pediatric Surgery, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia

Malformations account for most cases of childhood chronic renal failure and are often associated with obstructed urinary tract. We hypothesisted that prenatal obstruction induces a defined biological programme which disrupts nephroenesis. We therefore examined cellular and molecular events after experimental obstruction in fetal sheep. Gestation in this species lasts 145 days and we generated complete unilateral ureteric obstruction at 90 days when only a few layers of glomeruli had formed. Since fetal human kidneys appositive non-functional organs can grow excessively, we also analyzed sheep contralateral organs and kidneys from twin fetuses in which the urinary tract was not manipulated (n = 6, all groups). At 10 days, obstruction generated hydronephrosis and even after drainage of the pelvis, kidney weight was greater than contralateral or unoperated organs. In obstructed kidneys, there was a failure of de novo nephrogenesis as assessed by fewer nephron precursors that expressed PAX2, a transcription factor required for their growth. Deeper in the cortex, we found evidence of glomerulocystic disease with massively dilated Bowman's speces with parietal glomerular epithelia expressing PAX2 and proliferating cell nuclear antigen. Our further observation of pyknotic nuclei in tubules prompted quantification of apoptosis using propidium iodide: point prevalence was increased in obstructed kidneys. Hence, both proliferation and death are upregulated, as we reported in human kidney malformations.

In obstructed kidneys, medullary collecting ducts and loop of Henle were reduced with increased urinary [Na], [K], osmolarity and (lactate), suggesting altered distal tubules electrolyte handling and increased medullary anaerobic glycolysis. We conclude that complex aberration of morphogenesis, gene expression, and cell turn over and urine composition occurs relatively early after fetal ureteric obstruction. Understanding such mehanisms may allow the design of therapies to enhance normal nephrogenesis.

Presented at the: 12 th Saudi Urology Conference

Al Hada and Taif Armed Forces Hospitals Program

23-25 February 1999 (7-9 Dhu Al Qa'dah 1419)

Non-intubated versus intubated pyeloplasty in children: The kkuh experience

A. Al Qarni, K. N. Fouda

Department of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

Background: Non-intubated dismembered pyeloplasty has evolved as an acceptable technique in treating PUJ obstruction. Contrary to the conventional intubated technique, several studies have shown that it is followed by less duration of hospital stay and the annoyances of multiple tubings that would also require re-hospitalization for extraction should internal stenting is chosen. Meanwhile, a slightly higher incidence of complications with the non-intubated technique is as well reported. Herein we present our experience comparing both techniques in the Paediatric Urological Service of KKUH.

Patients and Methods: From 1998 through 2000, we reviewed in a retrospective manner all patients who underwent dismembered pyeloplasty due to proved PUJ obstruction. These were further classified according to the intrubation nature of the procedure into group A: non-intubated pyeloplasty and group B that represents the intubated group by DJ stenting. Both groups were compared with regard to the duration of hospital stay till all tubings were removed and postoperative complications with special emphasis on recurring obstruction and urosepsis. Follow up included a renal sonography at 1,6,12 months and on yearly basis thereafter 99 TC-DTPA scintigraphy and retrograde studies were reserved for cases of suspected recurring obstruction. Redo cases as well as those associated with concomitant VUR were excluded from the study.

Results: There were 22 patients with proved PUJ obstruction (age range 3 months - 12 years). Group A included 12 patients while group included 10. The average hospital stay was 5.1 days for group A compared to 5.8 days for group B. Those in the latter group required rehospitalization 1 month after discharge for DJ stent extraction. None of the patients in group B showed evidence of recurring obstruction, while 2 patients in group A had evidence suggestive of obstruction on sonography and nuclear scans, yet this was denied by retrograde studies giving an overall equal success rate in both goups.

Conclusion: Non-intubated dismembered pyeloplasty stands as an acceptable technique for correcting proved PUJ obstruction with cure results comparable to the intubated technique. It has a superior advantage of reducing the duration of hospital stay and avoiding rehospitalization for extraction completion. It is our impression that it should set out the new "gold standard" in the surgical correction of PUJ obstruction, while the intubated technique should reserved for redo case and those associated with concomitant VUR.

Presented at the: 14 th Saudi Urology Conference

King Fahd Military Medical Complex - Dhahran

13-15 February 2001 (19-21 Dhu Al Qa'dah 1421)

Outcome of ureteropelvic obstruction in the first year of life

K. Al Ghamdi, A. Al Jaser, K. N. Fouda, A. Al Qarni

Division of Urology, Security Forces Hospital, Department of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia

The introduction and current widespread use of diagnostic maternal ultrasound has produced increase in number of asymptomatic newborn being diagnosed with hydronephrosis. It is reasonable to question the risk of benefit ratio as well as urgency for pyeloplasty during the first year of life. Clinical and experimental studies suggest that prompt release of congenital UPJ improve long-term renal function. We reviewed our experience with (35) pyeloplasty in (33) infant performed between 1992 and 2000 with minimum one year follow up in two centers in Riyadh. The (14) patients who underwent operation before they were 3 months compared to (19) patients operated upon from 4-12 months of their age. The surgical result, benefit and complication of pyeloplasty in the first year of life were described and discussed.

Presented at the: 14 th Saudi Urology Conference

King Fahd Military Medical Complex - Dhahran

13-15 February 2001 (19-21 Dhu Al Qa'dah 1421)

Antenatal hydronephrosis

Michael P. Leonard

Department of Pediatric Urology, University of Ottawa Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

This lecture will discuss the topic of antenatal hydronephrosis. Although other causes will be touched on briefly, the primary focus will be on the issue of indeterminate neonatal hydronephrosis (INH)/ureteropelvic junction obstruction (UPJO). Specifically, a review of criteria utilized to differentiate between INH and UPJO will be undertaken. In addition, a review of several clinical series examining the utility of these criteria will occur. At the completion of the lecture, the following objectives will be reached:

Understanding of the methods by which antenatal hydronephrosis is detected and defined

Knowledge of the assessment protocol for children with antenatal hydronephrosis

Appreciation of the criteria by which one attempts to differentiate INH and UPJO.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

The non-intubated versus the intubated "routine" pyeloplasty in children: Further experience from two saudi referral centres

S. M. Soliman, K. Fouda-Neel, T. Khatrawi

Department of Urology, King Khalid University Hospital, Department of Surgery, Security Forces Hospital, Riyadh, Saudi Arabia

Purpose: To verify and compare the impact of internal JJ stenting as an exclusive method of intubation versus non-intubation on the surgical outcome of the "routine" pediatric dismembered pyeloplasty with regard to the length of hospital stay and postoperative complications at short and long term.

Patients and Methods: From June 1998 to February 2002, we reviewed the records of all children operated by pyeloplasty for PUJ obstruction at 2 Saudi referral centers (King Khalid University Hospital and Security Forces Hospital). These were further classified according to the intubation nature of the procedure into group I: intubated by JJ stenting and group II: non-intubated. Both groups were compared with regard to duration of penrose drainage, duration of initial hospitalization, overall hospitalization inclusive for readmissions related to the procedure, short term complications and recurring obstruction. Follow up was primarily based on serial renal sonography. Nuclear scans and retrograde studies were reserved for cases failing to show improvement on postoperative sonograms. Reoperative cases, those with concomitant lower tract pathologies, and cases intubated by means other than JJ stenting were excluded from the study. Data are presented as mean + SD (range). Differences between both groups were considered statistically significant when p < 0.05.

Results: There were 64 patients (64 renal units) eligible for inclusion. Group I included 29 patients while group II included 35. The durations of penrose drainage and hospital stay for group I were 3.5 + 2.2 (2-14) and 5.2 + 3.1 (3-21) days compared to 4.9 + 1.7 (2-10) and 5.8 + 1.7 (3-10) days for group II respectively (p < 0.05). Prolonged leakage occurred in 3.5% (1/29) of group I versus 14.3% (5/35) in group II (p = 0.2090). UTI occurred in 13.8% (4/29) of group I versus 5.7% (2/35) in group II (p = 0.3975). Proximal stent migration occurred in 2 cases of group I. Recurring obstruction occurred in 3.6% (1/28) of patients in group I and in 9% (3/33) of patients in group II (p = 0.1675).

Conclusion: For the routine pyeloplasty, both techniques offer comparable results in terms of the total duration of hospital stay and the overall early complication rate. Nevertheless, the relatively small number of patients did not allow to draw solid conclusions regarding the issue of recurring obstruction in spite of an apparent less tendency with intubated repairs. The need of a multicentre prospective randomized clinical study with uniform inclusion criteria is ascertained to close the final chapter on this issue.

Presented at the: 16 th Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

2-4 March 2004 (11-13 Muharram 1425)

Laser endopyelotomy in children with uretero-pelvic junction obstruction (initial report)

Farris Ayyat

Department of Urology, Dhahran Health Center, Saudi Aramco, Dhahran, Saudi Arabia

Introduction: The treatment of symptomatic uretero-pelvic junction obstruction (UPJO) in children has been swinging from the standard open pyeloplasty to conservative method and laparoscopic repair. Holmium laser (HL) endopyelotomy is relatively a new technique with minimal bleeding and short duration.

Objective: To evaluate the results of (HL) in treating (UPJO) in children regarding efficacy duration of procedure, blood loss and hospital stay.

Methods: This is a prospective study of (HL) endopyelotomy on 6 children with proven UPJO by renal ultrasound and diuretic MAG3 renogram. Study took place at (DHC) Saudi Aramco at Dhahran, Saudi Arabia, between January and September 2004. One patient had a failed dismembered pyeloplasty. Mean age was 3 years (9 months to 7 years). An antegrade renal access was done in the operating room, HL was used, the technique will be shown. A double J stent was left indwelling for 6 weeks. Renal ultrasound was scheduled for 3, 6, and 12 months. MAG3 renogram at 4 and 12 months. One patient could not be cannulated intra-operatively and turned into an open pyeloplasty. All were kept on prophylactic antibiotic.

Results: An average follow up of 7 months and the shortest 4 months. The 4 patients underwent renal ultrasound and MAG3 renogram in 3.

Presented at the: 17 th Saudi Urological Conference

King Fahd Military Medical Complex

8-10 March 2005

Prenatal diagnosis and postnatal management of uropathy

Yann Revillon

Department of Pediatric Surgery, Des Enfants Malades, Paris, France

Embryology: The excretory system develops from the mesonephric duct while the kidney itself differentiates from the metanephros. The branching process is completed by 20 weeks, but the induction of the mesochyme by the epithelial ureteric structures is not completed before 32-36 weeks. Foetal urine production begins by 11-12 weeks. The cloaca becomes separated into anterior and posterior portions by the recto-vesical septum at 6 weeks. The foetal bladder can be identified from 11-12 weeks. Kidneys can be imaged at 11-12 weeks. The cortico-medullary differentiation takes place between 18 and 24 weeks. The urethral canal in boys can be explored at 26-27 weeks.

Urinary Tract Anomalies:

Obstruction of the ureterophric junction is the most common of the foetal urinary tract. After birth, cystography, sonography and scintigraphy (MAG 3 + Lasilix) is useful to confirm the diagnosis and to choice the treatment

Mega-ureter is the result of a dysfunction at the uretero-vesical junction. Spontaneous relief of this dysfunction often occurs in the first year of life

Ureterocele is a cystic dilatation of the distal intravesical ureter. It is often associated with a double ureter. The ureterocele is at the lower ureteric orifice. A large ureterocele can obstruct the bladder neck.

Obstruction of the bladder outlet: The most common cause is posterior urethral valve. The kidneys may be dysplastic, resulting in a variable degree of renal failure. Fulguration of the valve is the post natal treatment.

Reflux: It is a common disorder usually diagnosed post natally. Direct imaging of the reflux is sometimes possible. The potential benefit of prenatal diagnosis is to avoid postnatal urinary infection.

Prune belly syndrome: It is described as the association of deficient abdominal wall, vesical distension, renal dysplasia and cryptorchidism. The prognosis depends on the renal function.

Kidney anomalies: Bilateral agenesis is a lethal condition. Unilateral renal agenesis remains asymptomatic.

Duplex kidney: The upper kidney usually presents with some degree of outflow obstruction.

Multicystic dysplasia: Spontaneous involution of the multicystic kidney is usual in postnatal life.

Autosomal recessive polycystic kidney disease: It is characterized by enlarged kidneys. The liver is always involved. In uretero, the expression of the disease is variable. The gene has been mapped.

Autosomal dominant polycystic kidney disease: It is a common etiology of enlarged hyperechogenic kidney. The diagnosis is easy when renal cysts are present in one of the parents. The gene has been mapped.

Prenatal management: Extra urinary anomalies should be assessed by a complete sonography. The incidence of chromosomal anomalies is reported as high as 12% in foetal renal defects and karyotypary should be performed. The foetal renal function is based on sonography and on foetal urine analysis (sodium, beta 2 microglobulin, calcium, phosphorus, glucose).

Foetal therapy: It has been considered for obstruction of the urinary tract. The approach consists in by passing the obstruction with percutaneous ultrasound guided uro-amniotic shunting. One end of a double pigtailed is inserted in a dilated pelvic cavity or into the bladder. Foetal uro-amniotic shunting is not indicated when irreversible renal damage has occurred.

Conclusion: Prenatal diagnosis improves the post-natal management of uropathy.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Comparative analysis of 3 different approaches for pediatric pyeloplasty

L. Braga, M. Al Mandil, A. E. Khoury, W. Farhat

Department of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada

Aim of the Work: Anderson Hynes dismembered pyeloplasty is the technique of choice for correction of ureteropelvic junction obstruction (UPJO) in children. The selection of surgical access is mostly driven by surgeon preference and can be performed laparoscopically, through a flank incision, or through a dorsal lumbotomy. A comparative analysis involving these 3 different approaches has not been previously reported.

Patients and Methods: A retrospective chart review was conducted for all patients who underwent pyeloplasty between Jan 2005 and Aug 2007. Of 53 laparoscopy pyeloplasties, we selected 29 performed by a single surgeon and compared them to 54 age matched cases who had an open approach (32 flank and 22 dorsal lumbotomy). Age of surgery, operative time, hospital stay, complication and failure rates were evaluated.

Results: Variables Lap (n = 29) Flank (n = 32) Dorsal (n = 22) p (Anova). Age (years): 7.9 8.0 7.2 0.49. Operative time (min): 187.8 163.9 167.7 0.02. Hospital stays (days) 2.3 3.6 3.3 <0.001. Complications: (%) 3 (10.3) 1 (3.1) 1 (4.5) 0.39. Failure/Redo: (%) 1 (3.4) 1 (3.1) 0 (0) 0.67. Follow up (months): 13.5 24.9 22.6.

Conclusions: Although mean operative time was greater for the laparoscopic group versus open cases, mean hospital stay was significantly shorter. Laparoscopic surgical time gradually improved over time, reaching those of flank and dorsal lumbotomy patients. Overall, the success rate was similar for the 3 pyeloplasty approaches. Out data do not favor one particular surgical access over the others. Future studies on cosmesis and pain control may reveal more divergent outcomes for these 3 approaches.

Presented at the: 20 th Saudi Urological Conference

King Fahad Hospital of the University - Tabuk

18-20 March 2008

Prognosis of prenatally detected severe uropathy in female fetuses: A multicenter study of 130 cases

H. Al Hazmi, S. Dreux, A. Delezoidey, Y. Dumez, M. Dommergues, S. Lortat-Jacob, R. Favref, A. El Ghoneimi, F. Muller

Department of Urology, Hopital Robert Debre, University Paris, Paris, France

Objective: To evaluate the outcome of prenatally diagnosed uropathy in female fetuses.

Materials and Methods: During the period 1986-2006, 1032 fetal urine samples were sent from different institutions to our laboratory for urinalysis in order to evaluate fetal renal function after the detection of bilateral uropathy. We have limited our study to 130 female fetuses. Unilateral uropathy or mild hydronephrosis were excluded. The prenatal parameters analyzed were: age at diagnosis, renal ultrasound, amniotic fluid, urine analysis. Prenatal and postnatal outcome were analyzed.

Results: Bladder was dilated in 77 cases (59%), of which 29 (22.3%) presented with isolated bladder dilation. The whole urinary tract was dilated in 20 (15.3%), whereas isolated hydronephrosis was observed in 34 (26%). Associated malformations were observed in 64 cases (49.2%), of whom 37% were prenatally diagnosed at ultrasound. Aneuploidies represented 6% of cases and complex syndromes represented 40%. Cloaca was present in 22 cases (34%) and MMIHS in 12 (19%). The infant was alive in 56 cases (43%), of whom 12 (23%) had associated unrelated malformations. In utero, stillborn, or infant death was observed in 19 cases (15%). Termination of pregnancy was performed in 51 cases (39%), of whom 12 for severe renal failure, and 39 due to associated malformations.

Conclusion: Our study underlines the poor prognosis of antenatally detected uropathy in females. The high rate of associated malformations needs a careful prenatal evaluation and the use of available methods to investigate renal function. These elements are necessary to provide a reliable parents counseling.

Presented at the: 21 st Saudi Urological Conference

North West Armed Forces Hospital - Tabuk

14-16 April 2009


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