Anomalie de la jonction pyélo-urétérale de diagnostic anténatal : traitement chirurgical ou médical ?

Summary: The ureteric-pelvic junction (UPJ) is an uropathy that his management had profoundly evolved during these last thirty years, both from the point of view of the care and diagnosis. Purpose: The purpose of this study is to discuss a diagnostic and therapeutic strategy of this uropathy. Patients and methods: This study concerning 53 children (59 UPJ with antenatal diagnosis) brought together in the unity of paediatric surgery of 1999 in 2008. We classified the patients according to their care: group I: surgical at once; group II: medical then secondarily surgical; group III: purely medical. Results: This study was about 34 boys and 19 girls with a sex ratio of 1.8. The UPJ was noticed in 26 cases to the left. The vesico-ureteral reflux was the most frequent associated abnormality (five cases). The majority are a part of the group I (42%). The anteroposterieur diameter in the ultrasound was on average 32.65mm for the group I while it was respectively 25.86 and 14mm for the group II and III. The differential renal average function in the scintigraphy (DTPA or MAG III) was normal (46%) in the group III while was 35 and 38% respectively in the group I and II. The nephrogram was obstructive in 72 and 75 % of the cases respectively in the group I and II and only in 16 % of the cases in the group I. The final comparison of the differential renal function between the group I, and the group II, does not show a significant difference (P <0.005). Thirty-three patients benefited from an initial medical supervision. Only sixteen children (48%) had pyeloplasty. Conclusion: The big frequency of the spontaneous improvements at the infant by simple tissular maturation (30% in this series), and the low incidence of the postoperative complications of the patients operated late do not authorize any more the premature pyeloplasty in front of an antenatal diagnosis UPJ. [Copyright &y& Elsevier]