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19–22 APRIL, 2017, BARCELONA, SPAIN
S17-14 (P without presentation)
SURGICAL MANAGEMENT OF PRIMARY OBSTRUCTIVE
MEGAURETER IN CHILDREN WITH PRENATAL
DIAGNOSIS OF HYDRONEPHROSIS – WHAT TO EXPECT
IN ADULTHOOD
Jawdat JABER
1
, Stanislav KOCHEROV
2
, Amicur FARKAS
2
and Boris CHERTIN
3
1) Shaare Zedek Medical Centre, Pediatric Urology, Jerusalem, ISRAEL - 2) Shaare Zedek Medical Center, Jerusalem,
ISRAEL - 3) Shaare Zedek Medical Centre, Jerusalem, ISRAEL
PURPOSE
We evaluated whether improved renal function after ureteral reimplantation for prenatal UVJ ob-
struction persisted through puberty.
MATERIAL AND METHODS
A total of 62 patients (38 males and 24 females) with a prenatal diagnosis of hydronephrosis that
led to the postnatal diagnosis of UVJ obstruction were followed at our department from 1989 to
2000. Of the patients we reviewed the records of 21 who underwent ureteral reimplantation and
completed puberty. We have examined renal function upon, after surgery and after puberty, the
degree of hydronephrosis, and the incidence of UTI during the follow up.
RESULTS
Hydronephrosis was on the right side in 5 children (23.8%), on the left in 12 (57%), and bilateral
obstrction was found in three children (14.2%). According to Society for Fetal Urology classification
at first presentation postnatal hydronephrosis was grades 3 and 4 in 10 (47.6%) and 11 (52.4%)
children respectively.
Initially the relative renal function was less than 40% in 7(33%), and less than 30% in the remain-
ing 14 (67%) children. Preoperative renal function relative +/- SEM finding was 28 +/- 4.3% in all
reviewed patients. After reimplantation renal function improved from 28% +/-4.3% preoperatively to
36.4 +/- 5% (p <0.0001). It remained stable at 35.5 +/- 5.6% after puberty in all reviewed patients.
Two patients suffered from febrile urinary tract infections and were diagnosed to have VUR. They
required subsequent endoscopic correction.
CONCLUSIONS
To our knowledge our data show for the first time that successful ureteral reimplantation after the
prenatal diagnosis of UVJ obstruction is associated with improved renal function throughout puberty.