Postnatal Behavior and Outcome of Antenatally Detected Hydronephrosis and Predictors for Surgical Intervention

Objective: To observe the postnatal behavior and outcome of antenatally detected hydronephrosis due to UPJ obstruction and to determine the predictors for surgical intervention. Study Design: Prospective, observational, descriptive study. Subjects: 24 babies with 33 renal units with hydronephrosis due to UPJ obstruction detected antenatally. Methodology: Hydronephrosis grading was done according to SFU grading. All patients were initially treated non-operatively regardless of the initial degree of hydronephrosis, differential function, or diuretic renogram and followed up until either there was objective evidence that the hydronephrosis improved or obstruction existed. Results: Of the 24 neonates with 33 renal units majority were males and 38% had bilateral hydronephrosis. 58% hydronephrotic units improved and 42% required pyeloplasty later on but none required nephrectomy. None of SFU Grade-I, 37% patients of SFU Grade-II, 47% patients of SFU Grade-III and all patients of SFU Grade-IV underwent surgery. Presence of sign/symptoms, obstructive curve and deterioration in differential function and paradoxical hyper functioning indicate the need for surgery. Conclusion: Postnatal outcome can be predicted from antenatal SFU Grade of hydronephrosis; as the grade increases future chances of surgical intervention increase.