A 6-month-old boy has an antenatally detected left hydronephrosis. Ultrasound shows a dilated renal pelvis with normal calibre ureters. A MAG3 diuretic renogram reveals preserved but impaired drainage of the left pelvis after furosemide, with a split renal function of 34%. What is the definitive management?
- A Dismembered pyeloplasty (Anderson-Hynes) ✓
- B Serial ultrasound follow-up alone
- C Percutaneous nephrostomy
- D Endoscopic balloon dilation of the pelviureteric junction
Correct answer: A. Dismembered pyeloplasty (Anderson-Hynes)
Explanation
The child has pelviureteric junction obstruction with deteriorating split renal function below the accepted threshold of 40%, which is an indication for operative intervention. The Anderson-Hynes dismembered pyeloplasty remains the gold standard, excising the aperistaltic segment and creating a dependent funnel-shaped anastomosis. Serial imaging alone is reserved for mild obstruction with stable function above 40%. Nephrostomy is a temporising measure, not definitive treatment.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.