Obstructive Uropathy

Kumud P Mehta
Obstructive Uropathy - Management
Management of PUJ obstruction depends on:
- Unilateral PUJ with mild to moderate hydronephrosis with normal contralateral kidney-conservative medical management-prophylactic antibiotics for 1 year.
- Unilateral severe PUJ obstruction with reduced renal function(35% or less)- surgery indicated at six months.
- Bilateral PUJ obstruction:
If AP diameter of pelvis > 20mm - surgery
If AP diameter of pelvis < 20mm - monitoring with USG and if dilatation increases - surgery.

Pyeloplasty is the surgery done by 3 months on the side with greater dilatation or lesser function. Mostly contralateral surgery is required later on.

A regular follow up of child with obstructive uropathy is important even after surgery because many children need oral alkali therapy for acidosis, Vitamin D & calcium supplements for renal rickets and treatment to control anemia and hypertension which goes a long way in preserving renal function and helping in growth and development.

Yearly, S. Creatinine, USG and BP with growth monitoring is minimum requirement for follow up upto 15- 20 years of age for a case of obstructive uropathy diagnosed at birth.

Obstructive Uropathy Obstructive Uropathy 01/03/2001
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