الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Ureteropelvic junction (UPJ) obstruction is the most common cause of neonatal hydronephrosis. It has an overall incidence of 1:1500 and a ratio of males to females of 2:1 in newborns. It is a relatively benign condition that can resolve spontaneously. However, surgery may be needed in a significant part of patients. The widely accepted indications for surgery are an increasing AP diameter on ultrasonography, low or decreasing differential renal function, breakthrough infections while on prophylactic antibiotics or symptoms such as pain in older infants and children. However, the timing and accurate cutoff values are still controversial.
In this study, we prospectively followed infants who were born with antenatally diagnosed UPJO presented at our outpatient clinics for evidence of obstructive injury with a standard protocol with ultrasonography and renal scintigraphy. At the end of the study, we had 117 infants (92M&25F), and 30 of them had bilateral UPJO (a total of 147 renal units). Pyeloplasty was performed in 69 renal units (46.9%). The rest of them had either partial or complete resolution of hydronephrosis. Indications for surgery included; initial DRF ≤ 35%, progression of hydronephrosis on serial follow-up, > 5% DRF loss on subsequent studies, and recurrent UTI.
Multivariate analysis revealed that independent predictors for surgical intervention were; the initial APD (P-value <0.0001), initial DRF (P-value <0.002), presence of obstructive curve on renogram (P-value <0.0001), and occurrence of recurrent UTI during follow up P-value <0.0001). While, Cortical thickness, SFU grade 4 hydronephrosis, and UTD P3 (high risk) were not. In addition, receiver operating curve (ROC) analysis revealed that an APD of 23 mm (best cutoff) can predict the need for surgery, with a sensitivity of 69.6% and a specificity of 94.9%.
Conclusion:
In conclusion, no single protocol is ideal for all patients. Considering “surgery for all” can expose many children to unnecessary interventions. Although pyeloplasty is a relatively safe and highly successful intervention, complications can occur. In addition to the anesthetic risk in early life.
Antenatally diagnosed UPJO is a relatively benign condition that can be followed safely by an initial conservative approach unless there is evidence of obstructive injury on initial assessment. Anteroposterior diameter value (at the age of 1 week), DRF value (at the age of 6-8 weeks), and occurrence of recurrent UTI during follow-up are significant and independent predictors of the need for surgical intervention. Anteroposterior diameter, when used with a cutoff of 23 mm, is associated with high sensitivity and specificity in predicting the need for surgery. Therefore, even bilateral cases can be safely followed using a strict protocol.