MANAGEMENT OF SEVERE HYDROURETERONEPHROSIS IN INFANTS AND YOUNG-CHILDREN

Loop cutaneous ureterostomy and cutaneous pyelostomy are safe and effective means of temporary diversion with few complications. Reconstructive operation is delayed until the upper urinary tract shows maximum improvement in form and function and the patient''s tolerance for elective operation has improved. Results of reconstruction may be less than optimal and serious complications may arise. However, the staged approach is safe and effective. Experience with 29 patients led to a reassessment of the approach to patients with posterior urethral valves and a stronger inclination to primary valve resection, thus avoiding many of the reconstructive procedures ultimately associated with temporary diversion. Patients with posterior urethral valves who have hydronephrotic upper urinary tracts, normal or near normal serum chemistry studies and are free of infection may receive initial valve ablation. All patients with massive hydroureteronephrosis require long-term followup to ensure preservation of renal function regardless of the approach used.