Multicystic dysplastic kidney in the neonate: the role of the urologist.

The urological management of multicystic dysplastic kidneys (MCDK) in the pediatric patient is controversial. Historically, MCDK was rare, presenting with a palpable mass or symptoms, and was managed with open nephrectomy. Wilms’ tumour was listed on the differential diagnosis. Introduction of antenatal ultrasound transformed MCDK into a common condition which is generally asymptomatic at presentation. Observation through a MCDK registry established that the low risk of Wilms’ tumour developing in these kidneys did not justify nephrectomy, and that observation with periodic ultrasound was safe. However, a costeffective protocol for follow-up was never established. With the widespread adoption of pediatric laparoscopy, there is potential for the pendulum to swing back to surgical management of this condition. However, the current indications cited for surgical intervention are more to relieve the iatrogenic symptoms, such as parental anxiety and cost to the health-care system, caused by long-term observation than for any confirmed medical indication. With evidence-based medicine being the new standard, a literature review was carried out to determine whether perceived medical concerns regarding MCDK could be substantiated, and to determine what degree of urological investigation and observation were actually necessary for the neonate with a MCDK. The findings of this literature search are detailed in a 2007 article on the long-term urological follow-up of MCDKs1 and summarized below. A separate literature search was carried out regarding vesicoureteral reflux.