Résumé
Objective: Congenital giant hydronephrosis due to ureteropelvic junction obstruction is exceptional and treatment often requires nephrectomy of a poorly functioning kidney. However a more conservative approach by nephroplication is also possible. The objective of this study was to evaluate the long-term functional outcome of these kidneys treated by nephroplication during the neonatal period.
Material and Methods: From 1996 to 1998, 5 neonates with congenital giant hydronephrosis were managed in our department (3 antenatal diagnoses). The mean anteroposterior pelvic dilatation was 145 mm (range: 110-180 mm). All infants were treated by pyeloplasty with nephroplication, regardless of the preoperative ultrasound and scintigraphic appearance of the renal parenchyma.
Results: The mean follow-up was 9 years (range: 8-10 years). A marked initial reduction of global kidney volume was constantly observed (more than 50% of the initial volume). The mean relative renal function was 32.4% (range: 10-42%) without any residual obstruction. Renal growth was satisfactory in 4 cases (40 mm at I year 72 mm at 6 years) with an atrophic kidney in 1 case. No child developed hypertension or elevated serum creatinine.
Conclusion: Congenital giant hydronephrosis does not systematically justify primary nephrectomy even in the presence of a healthy contralateral kidney. Despite the pejorative initial ultrasound and scintigraphic appearance, which is always difficult to interpret, early nephroplication improves drainage of pyelocaliceal cavities, decreases the residual dilatation and allows significant nephron sparing in most of these children.