Antenatally detected pelvi-ureteric junction obstruction: concerns about conservative management

Objective To review the conservative management of antenatally detected pel vi-ureteric junction (PUJ) obstruction in children. Patients and methods The study included 121 children (142 kidneys) with ant enatally diagnosed PUJ obstruction managed over an 8-year period, including 21 who were affected bilaterally; the main focus of the study was on the 1 00 children affected unilaterally. The intent was to manage these patients conservatively, with immediate surgery (early pyeloplasty) only if renal fu nction was initially compromised (:renographic function < 40%). The indicat ions for surgery subsequently (delayed pyeloplasty) included either a deter ioration in renal function, the onset of symptoms or increasing hydronephro sis. Results The anteroposterior diameter and renal function were weakly and neg atively correlated. The kidneys in the delayed pyeloplasty group had a grea ter initial mean anteroposterior diameter than had those in the early or th e conservative groups (P<0.05). The improvement in renal function was the l ower in the delayed pyeloplasty group than in the early pyeloplasty group; the improvement was inversely related to the anteroposterior diameter. Conclusions The conservative management of some antenatally detected PUJ ob structions probably results in greater loss of function, which is not recov ered after surgery.