Problems in severe bilateral urinary tract anomalies.

Management of children with severe infravesical or bilateral ureterovesical obstruction with or without reflux is difficult. Our experience over 10 years includes 29 such children, 19 of whom presented in the first 3 months of life. At the time of diagnosis, 13 had severe disturbance of renal function. There were two deaths. Five children have severe and two a moderate reduction of renal function; twenty good renal function. There were ten nephrectomies and four heminephrectomies. Seven patients had a temporary and eight a permanent urinary diversion. However, four of the latter were later undiverted. Removal of an obstruction is not always followed by full restitution of function. It seems probable that renal dysplasia and developmental injury to the ureterovesical musculature set a limit to the therapeutic possibilities. Careful management is important, especially in neonatal cases, where extensive reconstructive procedures are technically demanding and the rate of complications is high.