Abstract
Objective:To report the case of a pediatric patient with bilateral hydronephrosis due to vesicoureteral junction obstruction (VUJO) that was treated non-surgically and to discuss the approach of this anomaly.Case Description:A 25-month-old boy was referred without complaints for consultation due to prenatal ultrasound showing kidneys with cysts. He was under antibiotic prophylaxis. No family history of kidney disease and/or inherited disorders was reported. Renal ultrasound (RUS) at 2 days of life showed bilateral hydronephrosis, thus ruling out the possibility of kidney cystic disease. Dynamic renal scintigraphy (DTPA) showed marked retention of the marker in the pyelocaliceal system bilaterally, with little response to diuretic drug. He was maintained under antibiotic prophylaxis, when a new RUS showed bilateral ureteral dilatation, abrupt stenosis in the ureterovesical transition region (0.2 cm caliber), moderate bilateral hydronephrosis, and slight renal cortical thickness, confirming the diagnosis of VUJO. At 2 years and 10 months of age, DTPA showed hydronephrosis and ureteral stasis in both kidneys secondary to stenosis at the vesicoureteral junction (VUJ) level, with preservation of kidney function and slow degree of emptying. We opted for a non-surgical approach. RUS at 10 years of age showed significant improvement of all parameters, with ureteral transverse diameter of 9 mm, preserved VUJ, and age-appropriate bilateral kidney development.Comments:VUJO is a major cause of prenatal hydronephrosis and can trigger a deterioration of kidney function. Its treatment is still controversial but should take into account the importance of clinical follow-up and serial imaging evaluation.
Highlights
With an estimated incidence of 36 cases per 100,000 births and higher prevalence in the male sex[1], vesicoureteral junction obstruction (VUJO) is characterized by a total or partial obstruction of urine flow in the distal portion of the ureters
These findings indicated the diagnosis of bilateral megaureter secondary to stenosis caused by VUJO and vesicoureteral reflux (VUR)
We reported a case of bilateral hydronephrosis detected at prenatal ultrasound and diagnosed as VUJO at 2 years of age
Summary
With an estimated incidence of 36 cases per 100,000 births and higher prevalence in the male sex[1], vesicoureteral junction obstruction (VUJO) is characterized by a total or partial obstruction of urine flow in the distal portion of the ureters. Its pathogenesis is associated with an abnormality or delay in the development of the muscles of the distal ureteral portion during the 20th week of pregnancy[3]. It is considered the second leading cause of prenatal hydronephrosis[2], defined as the dilation of the renal calyces and/or pelvis, which can lead to a progressive deterioration of kidney function and, irreversible damage to the organ. The treatment, has undergone few changes over time and, on some occasions, it still involves surgical intervention[6], with cutaneous ureterostomy[7], ureteral reimplantation[8], and nephrectomy as the most widely used techniques in cases of loss of kidney function[6]. New and less invasive endoscopic techniques emerged as novel surgical approaches[6,9]
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