Objective: Clarify the indications for surgery and diagnostic tests in patients prenatally diagnosed with structural abnormalities of kidney and urinary tract.
Material and methods: We reviewed the recent literature comparing the results with the questionnaire sended to 108 physicians registered on the meeting about their clinical practice (mainly pediatric nephrologists and urologists). We received 30 responses.
Results: Almost 90% of hydronephrosis antenatal diagnosed are not permanent. Patients with anteroposterior renal pelvis diameter <15 mm on the ultrasound made no earlier than day 3 of life, should not be subjected to invasive testing. Cystography is not recommended systematically for all children with dilated renal pelvis. Renal function loss in successive renograms is the main indicator of surgery. Antibiotic prophylaxis is recommended only in patients at risk.
Conclusion: Responses to the questionnaire overwhelmingly agree with the recommendations in the literature. The initial plan with these patients should be minimally invasive. Studies should be performed at birth in case of suspicion of common via or bilateral obstruction. In case of unilateral dilatation, evaluation should be performed after the third day of life. We recommend antibiotic prophylaxis at least until the end of the studies in severe hydronephrosis.

The most common cause of lower urinary obstruccion in male infants is posterior urethral valves. Although it is related to significant morbidity, prognosis has improved in recent years due to an earlier diagnosis when detecting oligohydramnios, bladder dilatation and hydronephrosis during the prenatal ultrasound evaluation. The aim of this note is to describe the presentation, treatment provided and the clinical course, in a case recently diagnosed in our center.

Introduction: With the great advances in the urological endoscopic surgery in the last years, a new minimal invasive alternative to open surgery in the treatment of primary obstructive megaureter has been used. We present the results of our experience in the endoscopic dilatation of the uretro vesicle stenosis during the last 4 years.

Material and method: Between the years 2005 to 2009 we present a total of ten have been treated through this technique. All of them complied with the criteria of the POM without associated reflux. In all cases the procedure consisted in a cytoscopy and the verification of stenosis and endoscopic dilatation of the same with a balloon. A double-J catheter was positioned and then withdrawn 1 month after the procedure. As a follow-up, an ultrasound monitoring is done as well as a cystography a month after, a renography at 3 and 9 months and posterior ultrasound monitoring in a serial manner.

Results: 60% of our patients were boys and 40% were girls. In 60% of them the primary obstructive megaureter was on the left side. 70% of the patients were diagnosed due to a prenatal suspicion and 30% after an ITU. The mean intervention age was of 14.4 months. The mean follow-up was of 29 months. All the patients improved their obstructive curves. As complications: one patient required the removal of the double-J catheter, 12 hours after, because it was located in the bladder, and two patients showed a ITU during the post operatory.

Conclusions: The endoscopic management of primary obstructive megaureter without uretro vesicle reflux is a new therapeutic approach which avoids an aggressive surgery in a child to do a urethral reimplantation. It is a feasible and effective technique which will need studies to a long term to be able to demonstrate its effectiveness.