Pelvi-Ureteric Junction Obstruction at Red Cross Children's Hospital, Cape Town: a Six Year Review

Congenital abnormalities of the kidney and urinary tract (CAKUT) are significant causes of end stage renal disease (ESRD) in children. Some of these abnormalities, when identified early, are amenable to treatment. In developing countries, very few published reports exist concerning the pattern and scope of CAKUT in childhood.This is a retrospective review of all patients with confirmed Pelvi-Ureteric Junction (PUJ) obstruction who were diagnosed antenatally with hydronephrosis between Jan 2002 and Dec 2007 at the Red Cross Children's Hospital, Cape Town. The clinical course of every patient was reviewed for a twelve-month period after confirmation of the diagnosis.One hundred patients, 80 males and 20 females, were included in the analysis. Thirty-two children (32%) had bilateral PUJ obstruction while the rest had unilateral involvement of the left (40%) or right (28%) kidney; overall, 132 kidneys were affected. mild, moderate and severe pelvic dilatation was present in 44.7%, 36.4% and 18.9% of affected kidneys respectively. One child required nephrostomy during the first day of life while eighteen children were treated by pyeloplasty. Urinary tract infection was confirmed in eleven children. At 12 months of follow-up, 83 affected kidneys (62.9%) demonstrated spontaneous resolution of PUJ obstruction while 14 (18.5%) kidneys improved after surgical intervention. Spontaneous resolution occurred more often in kidneys with mild to moderate pelvic dilatation.Spontaneous resolution of the PUJ obstruction occurred in a substantial proportion of children by twelve months of follow-up and complete resolution is more likely in mild to moderate dilatation.