Neonatal hydronephrosis due to primary vesicoureteral reflux: trends in diagnosis and treatment.

The records were reviewed of the 25 neonates found to have hydronephrosis due to primary vesicoureteral reflux at the authors' hospital in the 6 1/2-year period from January 1981 to June 1987. Modes of discovery and investigation, detection of associated lesions, treatment, and errors in both diagnosis and management were evaluated. Twenty-one of the neonates were boys. Fourteen cases were found at fetal screening, and the infants were asymptomatic. Inappropriate maternal/fetal intervention occurred in four cases: Three were incorrectly thought to have posterior urethral valves. The increased number of neonates found to have reflux is attributable to the widespread availability of obstetric ultrasonography and early screening of infants at risk for urinary tract abnormalities. Since the pathophysiologic characteristics of reflux are well understood, appropriate postnatal therapy can be instituted without delay.