Management of pelvi-ureteric junction obstruction in the first six months of life.

The authors report on clinical experience from 20 infants who were under six months of age, and who had been referred during the last five years for pelvi-ureteric junction obstruction. Any over-eagerness to arrive at an early diagnosis, mostly on the basis of prenatal ultrasonographic suspicion, must be tempered. Pyelocaliceal dilatation in newborn infants may not be related to obstruction, and overtreatment must be avoided by careful preoperative evaluation. Tc-DTPA diuretic computerised renography proved extremely reliable, whereas IVP may be unsatisfactory and misleading. Whenever surgical correction was indicated for a documented pelvi-ureteric junction obstruction, Anderson-Hynes pyeloplasty was performed, except in one case, where severe dysplastic changes in the hydronephrotic kidney necessitated nephrectomy. Splinting of the anastomosis was adopted in newborn with thin ureters. An infant with left pelvi-ureteric obstruction and right multicystic kidney died from renal failure a few days after right nephrectomy and left pyeloureteroplasty. No operative failure was otherwise observed, except for a transient anastomotic obstruction in two cases. Treatment of pelvi-ureteric obstruction in the first 6 months is a serious undertaking and should be restricted to experienced centres with facilities for intensive neonatal care, even for dialysis.