Pelviureteral Junction Research Articles

Expression of renal aquaporins is down-regulated in children with congenital hydronephrosis

This study investigated mRNA and protein expression of four renal aquaporin isoforms [AQP1, 2, 3 and 4 (AQP1-4)] in congenital hydronephrotic kidneys (HK) due to pelviureteral junction obstruction and normal control kidneys. The expression of AQP1-4 was evaluated in 22 children (15 boys, seven girls, aged 58.9+/-54.3 months) using semi-quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) techniques, immunoblotting and immunohistochemistry. Hydronephrosis was graded by ultrasound according to the Society for Fetal Urology. Both RT-PCR and immunoblotting showed significantly reduced mRNA and protein expression of AQP1-4 in grade IV compared with those in grade III HK and controls. Sequencing demonstrated 99% homology of AQP1-4 with those in GenBank. Positive immunoreactivity of AQP1 was found in plasma membranes of the proximal tubule, thin descending limb of Henle and descending vasa recta; AQP2 in the apical membrane of collecting duct principal cells; and AQP3 and 4 in the basolateral membrane of the same cells. In kidneys with grade IV hydronephrosis there was reduction in the protein abundance of all four AQP isoforms which was more pronounced compared with the protein abundance seen in kidneys with grade III hydronephrosis and control kidneys. The expression of AQP1-4 mRNA and protein abundance is reduced in proportion with the degree of hydronephrosis graded by ultrasound in human congenital HK.

Concurrent ureteropelvic and ureterovesical junction obstruction in children: The value of retrograde pyelography

Ureteropelvic junction obstruction with concomitant ureterovesical junction obstruction is a rare condition whose treatment remains challenging [1-3]. Renal ultrasonography and diuretic renogram are universally utilized to assess a patient prior to pyeloplasty; however, the role of retrograde pyelography at the time of pyeloplasty is still debatable [5-7]. Herein, we describe two cases where the use of retrograde pyelography preoperatively helped to avoid pyeloplasty failure by allowing the surgeon to visualize a concurrent ureterovesical junction obstruction, which would not have been visible in the surgical field had the procedure been carried out without intraoperative imaging.

Laparoscopic Cranial Plication in Pelviureteral Junction Obstruction by Aberrant Lower Pole Artery

The standard management for pelviureteral junction (PUJ) obstruction is a laparoscopic dismembered pyeloplasty. We present the initial results of our experience of laparoscopic cranial transposition of lower-pole crossing vessels in the management of adult PUJ obstruction where crossing vessels were identified. All patients during the last 2 years who presented with PUJ obstruction caused by crossing lower-pole vessels underwent a laparoscopic transposition of the artery to a more cranial position and, in fact, plicated within the renal pelvis well above the PUJ to reduce the size of the baggy renal pelvis. Patients were followed up postoperatively with mercaptoacetyl triglycine renography as well as clinical symptom review at 3 months, 6 months, and then yearly. Seven patients have undergone this procedure so far. The mean follow-up period at present is 14 months (range 8-22 months). All patients had a nonobstructive renogram curve at 3 months and 6 months. One patient has had renography at 22 months, which still shows a nonobstructive drainage pattern. All patients have had a resolution of their pain and urinary tract infections. The mean operative time, including the retrograde study and Double-J stent insertion was 121 minutes (range 110-131 min) with a mean blood loss of 30 mL. The mean hospital stay was 2 days. There were no complications. Although currently the number of patients is small and follow-up is short, this procedure appears to be effective in relieving both symptoms and obstruction in patients with lower-pole crossing vessels. Other benefits include shorter operative time, less blood loss, as well as no risk of anastomotic stricture and urine leak when compared with a dismembered pyeloplasty. The Double-J stent can be removed within a few days (typically 5 in our hands) or even shorter where logistically feasible. This reduces stent-related complications.

Adult Wilms Tumor in the Renal Pelvis: Case Report With Review of the Literature

An 84-year-old man was referred to our hospital with gross hematuria. Abdominal computed tomography demonstrated a well-circumscribed enhanced mass in the right pelviureteral junction. Retroperitoneoscopic nephroureterectomy was performed because of a clinical diagnosis of renal pelvic carcinoma. Pathologic examination led to a final diagnosis of an adult Wilms tumor arising from the renal pelvis. This is the first report of a Wilms tumor in the renal pelvis of an adult patient.

Editorial comment

The role of TGF-β as a mediator of renal injury is well established. In brief, TGF-β binds to the TFG-β type II receptor, resulting in activation (phosphorylation) of the TGF-β type I receptor. The activated type I receptor, in turn, triggers cytoplasmic proteins (Smads) to complex, enter the nucleus, and upregulate transcription of pro-fibrotic target genes. The end result is extracellular matrix deposition, characteristic of end-stage renal disease. EGF is also thought to play a role in regulating renal injury. Interestingly, a recent publication has described opposing, species-specific, effects on renal function. 1 Kiley S.C. Thornhill B.A. Belyea B.C. et al. Epidermal growth factor potentiates renal cell death in hydronephrotic neonatal mice, but cell survival in rats. Kidney Int. 2005; 68: 504 Crossref PubMed Scopus (27) Google Scholar Renal expression of epidermal growth factor and transforming growth factor-beta1 in children with congenital hydronephrosisUrologyVol. 67Issue 4PreviewTo study the potential role of pelviureteral junction obstruction (PUJO) in causing progressive renal damage in children through the renal expression of epidermal growth factor (EGF) and transforming growth factor-beta1 (TGF-β1). Full-Text PDF

Renal expression of epidermal growth factor and transforming growth factor-beta 1 in children with congenital hydronephrosis

Objectives To study the potential role of pelviureteral junction obstruction (PUJO) in causing progressive renal damage in children through the renal expression of epidermal growth factor (EGF) and transforming growth factor-beta 1 (TGF-β 1). Methods The expression of EGF and TGF-β 1 was evaluated in the renal tissues of 25 children with congenital hydronephrosis by immunohistochemistry, in situ hybridization, and reverse transcriptase polymerase chain reaction techniques. Results Children with PUJO had a significant increase in TGF-β 1 and a marked reduction in EGF expression compared with controls. The TGF-β 1/glyceraldehyde phosphate dehydrogenase ratio in the hydronephrotic kidney and normal kidney was 0.53 ± 0.13 and 0.24 ± 0.10 respectively, and the difference was significant ( P = 0.000). The EGF/glyceraldehyde phosphate dehydrogenase ratio in the hydronephrotic kidney and normal kidney was 0.15 ± 0.06 and 0.55 ± 0.13, respectively, and the difference was also significant ( P = 0.0001). Positive correlations were found between the TGF-β 1 gene and the drainage clearance half-time ( r = 0.47; P = 0.018), TGF-β 1 protein and drainage clearance half-time ( r = 0.44; P = 0.028), TGF-β 1 gene and histologic grade ( r = 0.53; P = 0.006), and TGF-β 1 protein and histologic grade ( r = 0.76; P = 0.000). Negative correlations were found between the EGF gene and drainage clearance half-time ( r = −0.59; P = 0.002), EGF protein and drainage clearance half-time ( r = −0.61; P = 0.001), EGF gene and histologic grade ( r = −0.58; P = 0.003), and EGF protein and histologic grade ( r = −0.47; P = 0.019). Conclusions TGF-β 1 expression was increased and EGF expression was decreased in the renal tissue after clinical PUJO. The alterations of TGF-β 1 and EGF may play a potential role in the pathogenesis of renal damage in PUJO.

Glial cell line-derived neurotrophic factor and synaptophysin expression in pelviureteral junction obstruction

Objectives To examine the expression of neuronal markers in congenital pelviureteral junction (PUJ) obstruction as a causative factor. The findings from some investigations have suggested that defective neuronal innervation may play an important role in the pathogenesis of PUJ obstruction. Methods Using specific antibodies, we studied the neuronal markers of specimens from 12 cases of PUJ obstruction and 10 normal PUJs by immunohistochemistry using glial cell line-derived neurotrophic factor (GDNF), synaptophysin, S-100, and neurofilament. Results In the PUJ obstruction specimens, staining with hematoxylin-eosin and Masson’s trichrome revealed muscular hypertrophy and an increase in collagen tissue and fibrosis in the lamina propria and tunica muscularis. The most striking finding on immunohistochemistry was the marked nuclear staining of cells with synaptophysin in all layers of the PUJ obstruction specimens that was totally absent in the normal PUJ specimens. In addition, significantly less intense staining for GDNF was found in the PUJ obstruction specimens compared with the normal PUJ specimens. The underexpression of GDNF in PUJ obstruction specimens was localized in the muscular layer especially. Immunohistochemical staining for S-100 and neurofilament showed no differences in the expression level of these neuronal markers in normal and PUJ obstruction specimens. Conclusions Because GDNF is a survival factor for central and peripheral neurons, defective expression of GDNF could play an important role in the defective neuronal innervation of PUJ obstruction. Intense nuclear expression of synaptophysin in all layers of obstructed PUJ specimens suggested that obstructed PUJs have a serious structural abnormality.

Is retrograde stenting more reliable than antegrade stenting for pyeloplasty in infants and children?

ObjectivesTo compare antegrade and retrograde internal double-J stenting for pyeloplasty drainage in children. The success of placing the stent in position and the complications were compared in both groups. MethodsBetween October 2001 and December 2004, 42 children with unilateral pelviureteral junction obstruction underwent pyeloplasty by a single surgeon. Antegrade and retrograde double-J stenting was attempted in 17 children (mean age 1.3 years) and 25 children (mean age 1.5 years), respectively. Antegrade stenting was attempted during the pelviureteral anastomosis, and the retrograde stent was placed just before the operation by cystoscopy. Fluoroscopy was not routinely used to confirm stent placement in either group. The stents were removed 4 weeks later at cystoscopy. ResultsSuccessful stent placement without malpositioning was achieved in 14 (82%) of 17 and 24 (96%) of 25 children, respectively, in the antegrade and retrograde groups. The cause of unsuccessful stenting in both groups was the inability to cross the ureterovesical junction. The mean time taken for retrograde stenting was 9 minutes (range 6 to 15). All children with successful stent placement by either technique were discharged within 72 hours after the operation. The hospital stay for children with unsuccessful double-J stent placement varied from 7 to 10 days. No stent malpositioning occurred with retrograde stenting; 1 child in the antegrade stent group had a malpositioned stent in the distal ureter, which was retrieved at ureteroscopy. ConclusionsIn our experience, retrograde double-J stenting seems more reliable than antegrade stenting for pediatric pyeloplasty, with greater success and lower complication rates.

Minimally Invasive Surgery for Pelviureteral Junction Obstruction in Adults: A Critical Review of the Options

Minimally Invasive Surgery for Pelviureteral Junction Obstruction in Adults: A Critical Review of the Options

Postnatal unilateral pelviureteral junction obstruction: Impact of pyeloplasty and conservative management on renal function

Objectives To study the effect of pyeloplasty and conservative management on renal function in children with pelviureteral junction obstruction. Methods This prospective study included 65 children postnatally diagnosed with unilateral pelviureteral junction obstruction. On the basis of the patients’ symptoms and technetium-99m diethylenetriamine pentaacetic acid renal isotope scan findings, symptomatic patients or those with split function of the corresponding kidney of 40% or less were assigned to group 1 (n = 35) and underwent pyeloplasty. Asymptomatic patients with split function greater than 40% (group 2, n = 30) were treated conservatively. Patients who showed deterioration of renal function underwent pyeloplasty. The effect of both lines of treatment on renal function was evaluated. Results After pyeloplasty, group 1 had improvement in the glomerular filtration rate (GFR) in 30 (85.7%), stabilization in 2 (5.7%), and deterioration in 3 (8.6%) patients. In group 1, the comparison between the mean value of the baseline GFR (17.1 ± 7.7 mL/min) and its mean value at follow-up (28 ± 6.3 mL/min) showed an increase of statistical significance ( P <0.01). In the group 2 patients, conservative treatment resulted in improvement in the GFR in 12 (40%), stabilization in 3 (10%), and deterioration in 15 (50%) patients. In group 2, no significant difference was found between the mean baseline GFR (29.8 ± 9.8 mL/min) and its mean value at follow-up (31.2 ± 5.6 mL/min). Conclusions In patients with postnatal pelviureteral junction obstruction, early pyeloplasty is recommended if the corresponding GFR is 40% or less. Conservative management in patients with better function resulted in deterioration of renal function in 50%. Should this policy of treatment be chosen, meticulous follow-up is mandatory.

The sensitivity of antenatal ultrasound for predicting renal tract surgery in early childhood

To establish the sensitivity of antenatal ultrasound for identifying the need for renal tract surgery in infancy and early childhood. A retrospective analysis of the surgical records in children under 5 years of age undergoing renal tract surgery in a regional pediatric urological surgery referral unit was carried out. All records between May 1997 and July 2002 were examined to assess the relationship between prenatal ultrasound findings and postnatal surgical pathology. A total of 106 operations had been performed. The detection rate of multicystic renal dysplasia was 100% (17/17). The equivalent detection rates for pelviureteral junction obstruction, duplex renal system and vesicoureteral reflux were 82.8, 67 and 26.1%, respectively. None of the babies with renal tumors had abnormal antenatal ultrasound findings. The diagnosis of postnatal renal surgical pathology was made on the basis of prenatal scan findings in 59.6% of cases, while recurrent urinary tract infection led to the diagnosis in 26.0%. Approximately 40% of children requiring surgery for renal tract pathology will have a normal antenatal ultrasound examination. The prevalence of abnormal antenatal ultrasound findings varies depending on the type of renal tract pathology. Despite these findings, the commonest indicator for surgery remains abnormal prenatal scan findings, followed by recurrent urinary tract infections.

Experience in performing pyelolithotomy and pyeloplasty in children on day-surgery basis

Objectives To evaluate the success of implementing a day-surgery admission policy for pyelolithotomy and pyeloplasty in pediatric cases. Methods A retrospective audit of the urology day-surgery unit records was performed for the period of January 1994 to December 1998. The data included the number of patients and their sex, type of procedures performed, the criteria for case selection, and reported complications that required readmission. The mean patient age was 2.6 years. The decision to perform these procedures on a day-surgery basis was taken after completing preoperative investigations and making the decision for surgery. Several criteria were developed to ensure the success of this application. The parents’ understanding of the day surgery concept was the most important criterion. Pyeloplasties were performed using the Anderson-Hynes technique without stenting and were performed only for patients with an extrarenal pelvis. Pain control was delivered through wound infiltration with long-acting local anesthetic followed by oral non-narcotic analgesics. The immediate follow-up period was 4 to 5 weeks postoperatively, and long-term follow-up data were available for 2.5 to 3 years. Results During the study period, 209 patients underwent surgery for pelviureteral junction obstruction repair and 305 underwent pyelolithotomy for renal stones. Of these children, 85% were discharged the same day, with no reported readmissions during the immediate or delayed follow-up period. Conclusions The results of this study have demonstrated that day surgery can be safely used for children requiring open renal surgical procedures that have more traditionally been performed on an inpatient basis. This has considerable resource implications at little cost in terms of patient morbidity.

Coexisting pelviureteral and vesicoureteral junction obstruction in children: C. Pesce, L. Musi, P. Campobasso, et al. Eur J Pediatr Surg 13:367–371, (December), 2003

Coexisting pelviureteral and vesicoureteral junction obstruction in children: C. Pesce, L. Musi, P. Campobasso, et al. Eur J Pediatr Surg 13:367–371, (December), 2003

Percutaneous nephrostomy of nondilated renal collecting systems with fluoroscopic guidance: technique and results.

To retrospectively review experience with a double-puncture technique for percutaneous nephrostomy of nondilated renal collecting systems. Over a 5-year period, 15 patients (26 kidneys) without calyceal dilatation at ultrasonography (US) who required nephrostomy drainage were studied. Eleven patients (21 kidneys) had ureteral leaks or fistulas, one patient (one kidney) had a renal pelvic stone, one patient (one kidney) was suspected of having a ureteral tumor, and the final two patients (three kidneys) had acute nondilated renal failure. Mean age was 62 years (range, 20-78 years); 13 patients were men and two were women. A double-puncture technique was used with fluoroscopic guidance (supplemented with US in some patients who had renal failure). After intravenous administration of iodinated contrast material, a 22-gauge needle was inserted into the opacified renal pelvis, and double-contrast pyelography was performed by using air or carbon dioxide to allow visualization and distention of the nondependent calyces for definitive renal access with an 18-gauge 5-F sheath-needle set and a hydrophilic wire. After serial dilation, a nephrostomy or nephroureteral catheter was inserted. Success and major complication rates were studied by reviewing radiologic and clinical case notes. Catheter placement was successful in 25 (96%) of 26 kidneys after one, two, or three passes with the sheath-needle set. In all successful cases, the calyx was accurately punctured. There were two major complications. One patient developed hematuria that required transfusion but no further intervention; another sustained a renal pelvic injury, but this was believed to be due to excessive dilation of the pelviureteral junction, not faulty renal puncture. There were no cases of septicemia. With a double-puncture technique and air or carbon dioxide distention, nephrostomy was achieved in 25 (96%) of all nondilated renal collecting systems. There were two major complications (two [8%] of 25 kidneys, two [13%] of 15 patients), but only one was secondary to the renal puncture.

Angiotensin Converting Enzyme Gene Polymorphism in Asian Indian Children With Congenital Uropathies

To evaluate the role of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism as a risk factor for progressive renal damage in Asian Indian children with congenital uropathies. ACE I/D polymorphism was determined by polymerase chain reaction in 84 children with congenital uropathies and 80 unrelated healthy controls. The study group included primary vesicoureteral reflux (29 patients), pelviureteral junction obstruction (21) and posterior urethral valves (34). Mean patient age was 69.4 +/- 4.5 months, and mean followup period was 7.2 +/- 1.5 years. Serum creatinine, ultrasound, voiding cystourethrogram and dimercaptosuccinic acid scans were done to evaluate renal function. The ACE I/D genotype distribution was similar in the 84 patients, II in 37 (44%), DI in 30 (35.7%) and DD in 17 (20.2%), and 80 controls, II in 36 (45%), DI in 30 (37.5%) and DD in 14 (17.5%), chi-square 0.00, p = 1.0). Renal scarring was seen in 49 of 84 patients (58.3%), with D allele present in 35 of 49 (71.4%), compared to 12 of 84 patients (34.2%) in the nonscarring group (chi-square 4.2, p = 0.02). Progressive scarring and renal failure were seen in 23 (27.3%) and 26 (31%) of patients, respectively, with D allele present in 21 of 23 (91.3%) and 21 of 26 (81%), respectively (chi-square 5.4, p = 0.001). Multivariate analysis showed that D allele is an independent risk factor for renal damage. The presence of D allele in I/D polymorphism of angiotensin converting enzyme gene is associated with progressive deterioration of renal function in congenital uropathies. The D allele was also significantly associated with renal scarring independent of known risk factors such as grade of reflux, age at diagnosis, gender and urinary tract infection.

Evaluation of Painful Hydronephrosis in Pregnancy:: Magnetic Resonance Urographic Patterns in Physiological Dilatation Versus Calculous Obstruction

We evaluated magnetic resonance urography (MRU) appearances in symptomatic hydronephrosis in pregnancy and compared urographic patterns in physiological and calculous disease. A total of 24 consecutive pregnant women with symptomatic hydronephrosis underwent MRU, comprising an overview fast T2-weighted examination of the abdomen and pelvis, and thick slab, heavily T2-weighted MRU images, followed by focused, high resolution T2-weighted sequences obtained in an axial and coronal oblique plane through the level of ureteral caliber change. Of these 24 pregnant women 15 were found to have physiological hydronephrosis, 7 had calculous disease and 2 had preexisting urinary anomalies. MRU findings in physiological hydronephrosis cases were extrinsic compression of the middle third of the ureter, no filling defect and a collapsed ureter below it. Obstruction by ureteral calculi was seen at points of ureteral narrowing in the ureter, that is at the vesicoureteral junction in 2 cases, in the compressed mid ureter in 3 and at the pelviureteral junction in 1. Nonobstructive renal calculi were seen in another patient. Calculi presented throughout pregnancy but physiological hydronephrosis presented only in the late second and third trimesters. With distal calculi the MRU appearance was the double kink sign with constriction at the pelvic brim and the vesicoureteral junction with a standing column of urine in the pelvic ureter. There was renal edema and perirenal extravasation. Small calculi were only identified using high resolution T2-weighted magnetic resonance imaging. MRU is a valuable and well tolerated investigation for evaluating painful hydronephrosis in pregnancy. There are characteristic and differing urographic appearances in physiological and calculous obstruction.

Coexisting pelviureteral and vesicoureteral junction obstruction in children.

To address reasons for diagnostic failure in children with coexisting pelviureteral and vesicoureteral junction obstruction. A total of 11 children with coexisting pelviureteral and vesicoureteral junction obstruction are reported. This anomaly was recognised at presentation in only 5 (45%) of cases. In the remainder, correct diagnosis was made after initial pyeloplasty and a significant delay occurred in 3 children. In all 11 patients treatment consisted of pyeloplasty and subsequent reimplantation. A satisfactory postoperative course with improvement of urinary tract dilatation was noted in all 11 patients, while 8 of 11 patients showed preserved renal function at late follow-up. According to the few available data, our data confirm the difficulty of diagnosing coexisting pelviureteral and vesicoureteral junction obstruction in children. However, prompt recognition and relief of urinary obstruction in these patients is mandatory in order to prevent deterioration of renal function.

Unilateral urinary flow impairment at the pelviureteral junction: outcome of renal function with respect to therapeutic strategy

ObjectivesTo evaluate the renal function outcome in children with unilateral hydronephrosis and urinary flow impairment at the pelviureteral junction with respect to the therapeutic strategy. MethodsWe retrospectively selected 45 children with iodine-123–hippuran renography performed at diagnosis and after 3 or more years of follow-up. All children had bilateral nonobstructive pattern findings on diuretic renography at follow-up. Eleven children were treated conservatively, and 34 underwent unilateral pyeloplasty. Split and individual renal function, measured by an accumulation index, was computed from background-corrected renograms for the affected and contralateral kidneys at diagnosis and the follow-up examination. ResultsOf 11 children treated conservatively, 9 had normal bilateral function at diagnosis, all had reached normal function at follow-up. Of the 34 operated kidneys, 12 (38%) had initially normal function that remained normal at the follow-up examination, and 22 had impaired function that had normalized at the follow-up examination in 15 (68%). The function of the contralateral kidneys was increased in 5 of 8 children with persistently abnormal affected kidneys. Pyeloplasty was performed in 23 children (68%) and 11 children (32%) younger and older than 1 year, respectively. The function of the affected kidneys increased in both groups, but normalization occurred only in the younger children. ConclusionsOf the children selected for conservative treatment, 82% had normal bilateral renal function at diagnosis that was normal in all at the follow-up examination. Of the children treated surgically, 65% had initially impaired function of the affected kidney that improved in 87% after pyeloplasty. Normalization of function was observed only in children who were younger than 1 year old at surgery. Persistently low function of the affected kidney was compensated for by the contralateral one regardless of the age at surgery.

Pelviureteral Junction Obstruction: Correlation of Renal Cell Apoptosis and Differential Renal Function

We evaluated the relationship between renal biopsy changes and preoperative and postoperative renal scans in 29 male and 14 female infants with prenatal severe hydronephrosis and unilateral ureteropelvic junction obstruction. We also verified on immunohistochemical studies glomerular changes, degeneration of the epithelium of the proximal tubules, interstitial fibrosis and inflammation and apoptotic nuclei. In the children, all with prenatal diagnosis of hydronephrosis, ureteropelvic junction obstruction was diagnosed with 99mtechnetium mercaptoacetyltriglycine renal scan performed in all patients at ages 4 to 6 weeks to establish baseline differential renal function. All patients underwent renal biopsies at the time of pyeloplasty. The biopsy samples were examined with histological and immunohistochemical methods for antigens associated with apoptosis, such as clusterin, CD95, TDAG51 and bcl-2. Renograms were performed 3 months after surgical repair. The male-to-female ratio was 2.1:1. There was no difference between males and females in regard to baseline differential renal function of the affected kidney. All biopsy samples confirmed degeneration of the epithelium of the proximal tubules, interstitial focal fibrosis was found in 4 samples, mild chronic inflammation with lymphoid aggregates in 4 and focal Bowman's space dilatation in 1. No specimen demonstrated apoptotic nuclei as confirmed by immunohistochemical study which showed the presence of bcl-2 and absence of CD95, TDAG51 and clusterin, probably because there was no dysplasia in the samples examined. These results indicate absence of apoptosis in the kidney with preoperative uptake less than 40% and minimal histological changes.

Survival in second trimester oligohydramnios secondary to bilateral pelviureteral junction obstruction

The extent and onset of obstruction in hydronephrosis determine the varying degrees of renal impairment. Bilateral hydronephrosis, especially in combination with oligohydramnios, is considered a negative predictor for pregnancy outcome. We describe a case of bilateral pelviureteral junction obstruction causing severe oligohydramnios between 25 and 29 weeks of gestation. The prenatal and postnatal findings and treatment are demonstrated. In the presence of bilateral renal impairment and oligohydramnios, our patient had an unfavorable prognosis. The respiratory and renal function, however, were better than expected. We show how urinary tract reconstruction and neonatal intensive therapy can result in an acceptable outcome.