Ureteropelvic Junction Obstruction In Infants And Children

Congenital anomalies of the kidney and urinary tract (CAKUT) ‎‎account for more than 50% of the abdominal masses found in ‎‎neonates and involve about 0.5% of all pregnancies.‎Congenital ureteropelvic junction obstruction (UPJO) is ‎commonly ‎suspected when a prenatally detected dilatation of the ‎urinary tract is ‎found with a systematic ultrasound scan.‎The two most common approaches to define hydronephrosis ‎are the Society for Fetal Urology (SFU) grade and anterior–posterior ‎pelvic diameter(APPD)‎.A poor prognostic sign in bilateral hydronephrosis is the ‎development of oligohydramnios earlier than the third trimester.‎Prenataly, unilateral hydronephrosis rarely requires ‎intervention, as a normal contralateral kidney will prevent ‎oligohydramnios and intervention has not been proven to improve ‎outcomes.‎‎Only intervention can be considered in the case of severe ‎hydronephrosis causing compression of neighboring organs.‎‎The postnatal management of the newborn prenatally diagnosed with a ureteropelvic ‎obstruction should follow a systematic approach. Although ‎a majority of patients can be followed without surgical intervention, Surgical intervention will be required for ‎the most severe form of UPJ obstruction in 20% of patients.The surgical repair of UPJ obstruction has involved an open ‎surgical procedure that was performed retroperitoneally. The two ‎surgical approaches involve either a flank or dorsal incision, and ‎success rates have approached 100%.‎‎ Recently, a mini-incision approach has been described with ‎equal results when compared to a more traditional standard incision. ‎