Skip to main content

Advertisement

SpringerLink
Log in

Comparison of early surgical and conservative therapy in children with ureteropelvic junction obstruction

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Background

Ureteropelvic junction obstruction is a relatively common urologic problem in children. Most cases present with pelvicaliceal dilatation in antenatal period. Historically most UPJO cases were treated with surgical procedures, but recently many of these children have been treated by nonsurgical observational plans. We compared the outcome of children with UPJO treated in surgical and observational ways.

Methods

In a retrospective study, we assessed the medical history of patients diagnosed as UPJO, march 2011 to march 2021. The case definition was based on grade 3-4 hydronephrosis and obstructive pattern in dynamic renal isotopes can. Patients were put into two groups; Group 1 children were treated with a surgical procedure, and group 2 patients without any surgical procedure for at least a six months’ period after diagnosis. We assessed long-term events and improvement of obstruction.

Results

Seventy-eight children (mean age 7.32mo., 80% male) enrolled in the study, 55 patients in group one and 23 as group 2. Severe hydronephrosis was the problem of 96% of all patients significantly led to 20% in group 1 and 9% in group 2 (P < 0.001). Severe kidney involvement was observed at 91% in group 1 and 83% in group 2, decreased to 15% and 6%, respectively (P < 0.001). There were no significant differences in sonographic and functional improvement between the two intervention groups. Long-term prognostic issues; growth, functional impairment, and hypertension were not different between the two groups, but group 1 children experienced more recurrence of UTI than group 2 patients.

Conclusion

Conservative management is as effective as early surgical treatment in the management of infants with severe UPJO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yulia A, Winyard P (2018)Management of antenatally detected kidney malformations. Early Hum Dev 126:38–46

  2. Chiodini B, Ghassemi M, Khelif K, Ismaili K (2019) Clinical outcome of children with antenatally diagnosed hydronephrosis. Front Pediatr 7:103

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kelley JC, White JT, Goetz JT, Romero E, Leslie JA, Prieto JC (2016) Sonographic renal parenchymal measurements for the evaluation and management of ureteropelvic junction obstruction in children. Front Pediatr 4:42

    Article  PubMed  PubMed Central  Google Scholar 

  4. Weitz M, Schmidt M, Laube G (2017) Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review. Pediatr Nephrol (Berl Germ) 32(12):2203–2213

    Article  Google Scholar 

  5. Carlström M (2019) Hydronephrosis and risk of later development of hypertension. Acta paediatrica (Oslo, Norway 1992) 108(1):50–57

    Article  PubMed  Google Scholar 

  6. Cui X, He Y-B, Huang W-H, Chen L, Chen J-C, Zhou C-M (2020) Mini-laparoscopic pyeloplasty to treat UPJO in infants. Minimally Invasive Therapy & Allied Technologies29(5) 1–6

  7. Gadelmoula M, Abdel-Kader MS, Shalaby M, Abdelrazek M, Moeen AM, Zarzour MA et al (2018) Laparoscopic versus open pyeloplasty: a multi-institutional prospective study. Cent Europ J UroL 71(3):342–345

    Google Scholar 

  8. Goetz G, Klora M, Zeidler J, Eberhard S, Bassler S, Mayer S et al (2019) Surgery for pediatric ureteropelvic junction obstruction-comparison of outcomes in relation to surgical technique and operating discipline in Germany. Europ J Pediatr Surg Off J Austr Assoc PediatR Surg 29(1):33–38

    CAS  Google Scholar 

  9. Chen JC, Zhang QL, Wang YJ, Cui X, Chen L, Zhang JQ et al (2019) Laparoscopic disconnected pyeloplasty to treat ureteropelvic junction obstruction (UPJO) in children. Med Sci Mon Int Med J Exp Clin Res 25:9131–9137

    Google Scholar 

  10. Silay MS, Danacioglu O, Ozel K, Karaman MI, Caskurlu T (2020) Laparoscopy versus robotic-assisted pyeloplasty in children: preliminary results of a pilot prospective randomized controlled trial. World J Urol 38(8):1841–1848

    Article  PubMed  Google Scholar 

  11. Jenjitranant P, Viseshsindh W, Kochakarn W (2020) Is open pyeloplasty still the first choice of operation for ureteropelvic junction obstruction in children? Thai J Urol 41(1):15–18

    Google Scholar 

  12. Arena S, Chimenz R, Antonelli E, Peri FM, Romeo P, Impellizzeri P et al (2018) A long-term follow-up in conservative management of unilateral ureteropelvic junction obstruction with poor drainage and good renal function. Eur J Pediatr 177(12):1761–1765

    Article  CAS  PubMed  Google Scholar 

  13. Koc Z, Kara A, Bakal U, Balci T, Onur M (2017) Surgical and non-surgical follow-up results of ureteropelvic junction obstruction. J Kidney 3(144):2472–1220

    Google Scholar 

  14. Bajpai M, Chandrasekharam V (2002) Nonoperative management of neonatal moderate to severe bilateral hydronephrosis. J Urol 167:662–665

    Article  PubMed  Google Scholar 

  15. Vemulakonda VM, Sevick C, Juarez-Colunga E, Chiang G, Janzen N, Saville A et al (2021) Treatment of infants with ureteropelvic junction obstruction: findings from the PURSUIT. Network 53(8):1485–1495

    Google Scholar 

  16. Tabari AK, Atqiaee K, Mohajerzadeh L, Rouzrokh M, Ghoroubi J, Alam A et al (2020) Early pyeloplasty versus conservative management of severe ureteropelvic junction obstruction in asymptomatic infants. J Pediatr Surg 55(9):1936–1940

    Article  PubMed  Google Scholar 

  17. Deng Q-F, Chu H, Peng B, Liu X, Cao Y-SJJoIMR (2021) Outcome analysis of early surgery and conservative treatment in neonates and infants with severe hydronephrosis.Journal of International Medical Research 49(11): 1–8

Download references

Funding

This research was funded solely by the Mazandaran University of Medical Sciences (Grant number 327). The authors report no involvement in the research by the sponsor that could have influenced the outcome of this work.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran

    Mahgol Sadghian, Maedeh Gooran & Paniz Balmeh

  2. Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

    Seyed Abdollah Mousavi, Mahboubeh JafariSarouei & Hamid Mohammadjafari

  3. Department of Radiology and Nuclear Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Seyed Mohammad Abedi

Authors
  1. Mahgol Sadghian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seyed Abdollah Mousavi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seyed Mohammad Abedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mahboubeh JafariSarouei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maedeh Gooran
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paniz Balmeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hamid Mohammadjafari
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MS, HM, MA and SAM have given substantial contributions to the conception or the design of the manuscript. MJ, MG and PB to acquisition, analysis and interpretation of the data. All authors have participated in drafting the manuscript, HM revised it critically. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Hamid Mohammadjafari.

Ethics declarations

Conflict of interest

The authors declare no competing interests. The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sadghian, M., Mousavi, S.A., Abedi, S.M. et al. Comparison of early surgical and conservative therapy in children with ureteropelvic junction obstruction. Pediatr Surg Int 39, 147 (2023). https://doi.org/10.1007/s00383-023-05434-w

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00383-023-05434-w

Keywords

Search

Navigation