Neonatal surgical problems of the renal tract

Abstract

A significant number of neonates have problems involving the renal tract that may have surgical implications. Although previously presentation was with urosepsis and renal failure, prenatal detection now identifies large cohorts of asymptomatic neonates with urinary tract dilatation that require neonatal investigation. Bladder outflow obstruction must be diagnosed early and relieved surgically. Patients with upper tract obstruction accompanied by reduced function or bilateralsingle kidney involvement should undergo early pyeloplasty. Vesicoureteric junction obstruction with compromised renal function or symptoms may require temporary double J stent insertion, ureterostomy or reimplantation. Severe urosepsis or vesical dysfunction, as in the neuropathic bladder, may necessitate vesicostomy diversion. Most renal anomalies, however, can be managed conservatively, for example multicystic dysplastic kidney and vesicoureteric reflux. The care of bladder exstrophy patients has now become supra-regional with the aim of concentrating experience and hopefully improving clinical outcomes in terms of urinary continence, genital appearance and function.