In support of early surgical repair of ureteropelvic junction obstruction

Ureteropelvic junction (UPJ) obstruction is the most common urinary tract obstruction in children. Maternal ultrasonography has resulted in early diagnosis of an increasing number of neonatal cases, allowing repair of hydronephrotic kidneys before complications occur. We favor early treatment of congenital hydronephrosis, which should be performed prior to 6 months of age based on evidence of UPJ obstruction, increased pyelocaliceal dilatation, parenchymal thinning, contralateral normal kidney hypertrophy, and functional deterioration. One should not wait for evidence of progressive renal damage before making a diagnosis of obstruction. This therapeutic approach is supported by a review of the most relevant literature published on the subject and our clinical experience. None of the standard tests for measuring obstruction are ideal; hence, we recommend that the results of the different diagnostic procedures for UPJ obstruction should be examined collectively.