Clinical course of pediatric ureteropelvic junction obstruction according to the age at diagnosis

Purpose: There is no agreement concerning the management of ureteropelvic junction obstruction (UPJO) in children. We reviewed our experience over 10 years for children with UPJO to analyze the clinical course and desirable treatment modality. Materials and Methods: We reviewed the medical records of 80 consecutive children with UPJO and they were diagnosed between December 1994 and November 2004. There were 67 boys and 13 girls. A total of 94 kidneys in 80 patients were evaluated with urinalysis, ultrasonography, diuretic renogram and ^99mTc-DMSA renal scanning. The natural progression of disease, the management method and the perioperative outcomes were retrospectively compared. Results: Fifty of the 80 patients were prenatally diagnosed by fetal hydronephrosis or who were diagnosed at younger than 1 year (group A), and 30 patients were diagnosed at older than 1 year (group B). In group A, 18 patients underwent dismembered pyeloplasty before 1 year (A1) and 2 patients underwent nephrectomy due to severe deterioration of their renal function (<5%). Among the other 30 patients, delayed pyeloplasties were performed in 20 patients (A2) and 10 patients were managed conservatively (A3). In group B, 22 patients underwent pyeloplasty immediately (B1), and the other 8 patients underwent delayed pyeloplasty (B2). On the comparison of renal functional change among the patients in group A, the A1 patients had better renal functional improvement than the A2 and A3 patients. However, there was no statistical difference between the patients in B1 and B2. The postoperative complication rates were not significantly different in all the groups. Conclusions: It is thought that early operation is more effective for improving the renal function in children younger than one year.