A 5-year-old boy has antenatally detected left hydronephrosis. Ultrasound shows an AP diameter of 32 mm with cortical thinning. Diuretic renography (Tc-99m MAG3) shows delayed washout from the left pelvis with differential renal function of 45% on the left. What is the most appropriate management?

• A Annual ultrasound surveillance only
• B Percutaneous nephrostomy drainage
• C Dismembered pyeloplasty (Anderson-Hynes) ✓
• D Endopyelotomy

Explanation

Deteriorating differential function (below about 50 to 55%), increasing hydronephrosis on serial scans, or symptoms justify surgical correction of pelviureteric junction obstruction in a child. The gold standard operation is the dismembered Anderson-Hynes pyeloplasty, with success rates above 90%. Surveillance alone risks progressive loss of function when drainage is clearly impaired and function is falling. Nephrostomy is a temporising measure, not definitive treatment, and endopyelotomy is reserved mainly for secondary strictures in adults.

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.