Does early detection of ureteropelvic junction obstruction improve surgical outcome in terms of renal function?

Purpose: Prenatal ultrasound leads to the early detection of hydronephrosis . When followed by the early diagnosis of ureteropelvic junction obstructio n surgical treatment, if indicated, is associated with minimal morbidity. W e attempt to prove the benefits of this therapeutical approach from the poi nt of view of renal function. Materials and Methods: From 1979 to 1997, 452 patients with ureteropelvic j unction obstruction underwent dismembered pyeloplasty. Of these patients 11 3 with comparable data were retrospectively evaluated. Patients were divide d into group 1-50 who presented with prenatal hydronephrosis and group 2-63 with neonatal hydronephrosis who were lost to followup and who then presen ted with symptoms leading to the diagnosis of ureteropelvic junction obstru ction. In each group the diagnostic criteria and indications for surgery we re identical based on symptomatology, ultrasound and renal scan. Patients w ith bilateral disease, solitary kidney or vesicoureteral reflux were exclud ed from study. In groups I and 2 median patient age at surgery was 11 month s and 5 years, and average postoperative followup was 4.2 and 3.2 years, re spectively. Results: In 41 of the 50 group 1 and 60 of the 63 group 2 patients hydronep hrosis was severe and the renal pelvis was more than 3 cm. wide. Poor relat ive renal function (less than 30%) was significantly more pronounced in gro up 2 than in group 1 (56 of 63 patients or 89% versus 6 of 50 or 12%, p <0. 05). In all 113 patients postoperative followup ultrasound and renal scan r evealed significant improvement in hydronephrosis and washout curve pattern . There was a significant difference in the 2 groups in regard to renal fun ction improvement postoperatively (66% of group 1. versus 16% of group 2 pa tients, p <0.05). Conclusions: We believe that patients who undergo prenatal imaging and are diagnosed early with ureteropelvic junction obstruction should be carefully and meticulously followed. Special efforts should be made to ensure that p atients are not lost to followup. After any sign of deterioration develops early surgery is indicated. According to our data operative treatment resul ts in improved renal function.