Postnatal evaluation and management of suspected ureteropelvic junction obstruction

This algorithm summarizes the postnatal evaluation and management of an infant with a provisional diagnosis of UPJ obstruction on antenatal ultrasound.

MCDK: multicystic dysplastic kidney; MRI: magnetic resonance imaging; PUV: posterior urethral valves; RPD: renal pelvic diameter; SFU: Society for Fetal Urology grading system; UPJ: ureteropelvic junction.

* The timing of the postnatal ultrasound depends on prenatal findings:

For infants with unilateral hydronephrosis, the postnatal ultrasound examination should be avoided during the first 2 to 3 days of life because early studies can underestimate the degree of hydronephrosis due to extracellular fluid shifts.
For infants with features that raise concern for lower urinary tract obstruction (bilateral hydronephrosis and/or a dilated bladder) or hydronephrotic solitary kidney, the initial postnatal ultrasound should be performed within the first 48 hours after birth.

¶ Refer to UpToDate content on postnatal evaluation of hydronephrosis. The evaluation for lower urinary tract obstruction includes voiding cystourethrogram.

Δ We perform kidney ultrasounds every 4 months for the first year of life, every 6 months for the next 2 years, and then annually for life.

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Postnatal evaluation and management of suspected ureteropelvic junction obstruction