Surgical management of renal tract problems

The surgical management of renal tract problems in childhood focuses on relieving obstruction and correcting congenital structural abnormalities that predispose to infection. Most of these cases are detected prenatally on maternal ultrasound scanning and initial postnatal assessment is usually with the local paediatrician. It is important, therefore, that these clinicians have a detailed knowledge of the natural history of the conditions (e.g. pelviureteric junction obstruction, multicystic dysplastic kidney, vesicoureteric reflux, vesicoureteric junction obstruction, duplex renal anomalies), are able to select the most appropriate postnatal investigations, and have a clear understanding of when surgical referral is required. In this review we have covered the most common conditions requiring surgery and highlighted areas where advances in pharmaceuticals, materials and technology have provided new or alternative approaches to existing clinical problems. We have also discussed the current surgical management of rarer conditions such as the neuropathic bladder and bladder exstrophy. Due to constraints on article size, the management of malignant disease and urolithiasis has not been covered.