CONGENITAL DILATATION OR STENOSIS OF THE URINARY SYSTEM - INFLUENCE OF NEW DIAGNOSTIC CONCEPTS ON THERAPY

Background: Aim of the study was to investigate to what extent prenata l ultrasound does influence diagnostic and therapeutic procedures in n ewborn und infants with malformation of the urinary tract and how dyna mic functional examinations of the urinary tract changed the therapy o f urinary tract dilatations. Materials and methods: Time of diagnosis, diagnosis and therapy of 503 newborns and infants with congenital mal formation of the urinary tract seen in our clinic between 1980 and 199 2 were retrospectively investigated. Conclusions: In 219 of these chil dren diagnosis had been suspected antenatally. Across this period the ratio of children diagnosed antenatally increased up to 70% by 1992. T he total number of patients increased in parallel. The most severe com plication in children with unknown dilatation of the urinary tract was infection. Over 50% of all patients were presented with sometimes lif e-threatening urinary tract infection. Today dynamic functional studie s (frusemide assisted I-123-ortho-iodohippurane scan) are available to distinguish those children with dilatation from those with obstructio n. Corresponding to the improved early diagnostic methods, the indicat ions for operation changed. A simple dilatation without obstruction do es not need operation. Proved ureteropelvic junction obstruction is op erated primarily if renal function on the side of obstruction is impai red. If function of the compromised kidney is normal (Tc-99-Dimercapto succinic acid scan), then the procedure is conservative and the patien t is followed up by ultrasound and functional testing with radionuclid es. Percutaneous nephrostomy is carried out only in the case of a comp licated course. Obstruction in the ureterovesical junction is treated by temporary uretero-cutaneostomy. In 85% of our patients the vesicour eteral junction obstruction disappeared after one or two years (the me gaureter became slimmer in all cases) and uretero-cutaneostomy could b e closed. Additional surgery in the vesicoureteral junction was only n ecessary in case of persisting stenosis or because of other malformati ons.