POSTNATAL UNILATERAL PELVIURETERAL JUNCTION OBSTRUCTION: IMPACT OF PYELOPLASTY AND CONSERVATIVE MANAGEMENT ON RENAL FUNCTION AHMED A. SHOKEIR,MOHAMED T. EL-SHERBINY,HOSAM M. GAD, MOHAMED DAWABA, ASHRAF T.HAFEZ, MOHAMED A. TAHA, MOHAMED SAIDA, AND AHMED M. GHALY ABSTRACT Objectives. To study the effect of pyeloplasty and conservative management on renal function in children with pelviureteral junction obstruction. Methods. This prospective study included 65 children postnatally diagnosed with unilateral pelviureteral junction obstruction. On the basis of the patients’ symptoms and technetium-99m diethylenetriamine pentaacetic acid renal isotope scan findings, symptomatic patients or those with split function of the corresponding kidney of 40% or less were assigned to group 1 (n ⫽ 35) and underwent pyeloplasty. Asymptomatic patients with split function greater than 40% (group 2, n ⫽ 30) were treated conservatively. Patients who showed deterioration ofrenal function underwent pyeloplasty. The effect of both lines of treatment on renal function was evaluated. Results. After pyeloplasty, group 1 had improvement in the glomerular filtration rate (GFR) in 30 (85.7%), stabilization in 2 (5.7%), and deterioration in 3 (8.6%) patients. In group 1, the comparison between the mean value of the baseline GFR (17.1 ⫽ 7.7 mL/min) and its mean value at follow-up (28 ⫽ 6.3 mL/min) showed an increase of statistical significance (P ⬍0.01). In the group 2 patients, conservative treatment resulted in improvement in the GFR in 12 (40%), stabilization in 3 (10%), and deterioration in 15 (50%) patients. In group 2, no significant difference was found between the mean baseline GFR (29.8 ⫽ 9.8 mL/min) and its mean value at follow-up (31.2 ⫽ 5.6 mL/min). Conclusions. In patients with postnatal pelviureteraljunction obstruction, early pyeloplasty is recom- mended if the corresponding GFR is 40% or less. Conservative management in patients with better function resulted in deterioration of renalfunction in 50%. Should this policy of treatment be chosen, meticulous follow-up is mandatory. UROLOGY 65: 980–985, 2005. © 2005 Elsevier Inc. P elviureteral junction obstruction (PUJO) is by far the most common cause of pediatric hydro- nephrosis. 1 However, the management of PUJO re- mains controversial. It is difficult to choose an op- timaltherapy because of the high variability in function, degree of obstruction, extent of damage, and potential for regeneration in growing kidneys. 1 With the advent of prenatal ultrasonography, hy- dronephrosishasbeen identified and potential PUJO has been evaluated and treated at an early age. 2 However, the timing of surgical correction of presumed PUJO in infancy has varied. Proponents of early surgical intervention recommend early py- eloplasty for maximal recovery of renal function and preservation of renalparenchyma. 3,4 Advo- cates of delayed intervention 5,6 or prolonged ob- servation have noted spontaneous resolution of PUJO in some patients, with pyeloplasty reserved for those with an observed decrease in renal func- tion and reported improvement in function after repair. Others have followed up patients regardless of the obstructive drainage time when the differen tial renal function has been greater than 40%, and they performed pyeloplasty after the drainage time had become obstructive and the differential func- tion was 40% or less. 7,8 Nevertheless, most of the previous studies have focused on antenatally diagnosed PUJO that was followed up postnatally. In Western countries, From the Urology and Nephrology Center, Mansoura University, Mansoura, Egypt Reprint requests: Ahmed A. Shokeir, M.D., Ph.D., Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. E-mail: ahmedshokeir@hotmail.com Submitted: September 10, 2004, accepted (with revisions): De- cember 21, 2004 PEDIATRIC UROLOGY © 2005 E LSEVIER INC . 0090-4295/05/$30.00 980 ALL RIGHTS RESERVED doi:10.1016/j.urology.2004.12.065