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Upper Urinary Tract Obstruction

UPJO, Megaureter, Ureterocele

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Practical Pediatric Urology

Abstract

Paediatric urological surgery is often required for managing congenital and acquired disorders of the genitourinary system.

Clinical history and physical examination represent an important aspect in the management of infants and children with urological diseases. Radiological investigations are a useful adjunct to making an accurate diagnosis in all clinical cases. In recent years, there has been a considerable improvement in the detection of children with urological problems, mainly with the introduction of ultrasonography as a prenatal and postnatal screening tool. Two other investigations that are frequently used to confirm the diagnosis are voiding cystography and isotope renography.

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References

  1. Elder JS. Management of antenatal hydronephrosis. In: Puri P, editor. Newborn surgery. 4th ed. Florida: CRC Press; 2018. p. 1029–47.

    Google Scholar 

  2. Capolicchio J-P, Braga LH, Szymanski KM. Canadian Urological Association/pediatric urologists of Canada guideline on the investigation and management of antenatally detected hydronephrosis. Can Urol Assoc J. 2018;12(4):85–92.

    Article  PubMed  Google Scholar 

  3. Dhillon HK. Prenatal diagnosed hydronephrosis: the great Ormond street experience. Br J Urol. 1998;81:39–44.

    Article  PubMed  Google Scholar 

  4. Nguyen HT, Herndon CD, Cooper C, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010;6:212–31.

    Article  PubMed  Google Scholar 

  5. Silay MS, Undre S, Nambiar AK, Dogan HS, Kocvara R, Nijman RJM, Stein R, Tekgul S, Radmayr C. Role of antibiotic prophylaxis in antenatal hydronephrosis: a systematic review from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel. J Pediatr Urol. 2017 Jun;13(3):306–15.

    Article  PubMed  Google Scholar 

  6. Islek A, Güven AG, Koyun M, Akman S, Alimoglu E. Probability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed? Pediatr Nephrol. 2011;26:1837–41.

    Article  PubMed  Google Scholar 

  7. Roth CC, Hubanks JM, Bright BC, et al. Occurrence of urinary tract infection in children with significant upper urinary tract obstruction. Urology. 2009;73:74–8.

    Article  PubMed  Google Scholar 

  8. Babu R, Vittalraj P, Sundaram S, Shalini S. Pathological changes in ureterovesical and ureteropelvic junction obstruction explained by fetal ureter histology. J Pediatr Urol. 2019;15(3):240.e1–7.

    Article  CAS  Google Scholar 

  9. Growth T, Mitchell M. Ureteropelvic junction obstruction. In: Coran C, editor. Pediatric surgery, vol. 1. 7th ed. Saunders: Elsevier; 2012. p. 1411–25.

    Chapter  Google Scholar 

  10. Chow JS, Koning JL, Back SJ, Nguyen HT, Phelps A, Darge K. Classification of pediatric urinary tract dilation: the new language. Pediatr Radiol. 2017;47:1109–15.

    Article  PubMed  Google Scholar 

  11. Toiviainen-Salo S, Garel L, Grignon A, Dubois J, Rypens F, Boisvert J, Perreault G, Decarie JC, Filiatrault D, Lapierre C, Miron MC, Bechard N. Fetal hydronephrosis: is there hope for consensus? Pediatr Radiol. 2004;34:519–29.

    Article  PubMed  Google Scholar 

  12. Hodhod A, Capolicchio J-P, Jednak R, El-Sherif E, El-Doray AE-A, El-Sherbiny M. Evaluation of urinary tract dilation classification system for grading postnatal hydronephrosis. The J Urol. 2016;195:725–30.

    Article  PubMed  Google Scholar 

  13. Mendichovzky I, Solar BT, Smeulders N, Easty M, Biassoni L. Nuclear medicine in pediatric Nephro-urology: an overview. Semin Nucl Med. 2017 May;47(3):204–28.

    Article  Google Scholar 

  14. Gordon I. Pathophysiology of renal function and its effect on isotope studies in the workup of hydronephrosis. World J Urol. 2004 Dec;22(6):411–4.

    Article  PubMed  Google Scholar 

  15. Lee RS, Cendron M, Kinnamon DD, et al. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006;118:586–93.

    Article  PubMed  Google Scholar 

  16. Ahmad G, Green P. Outcome of fetal pyelectasis diagnosed antenatally. J Obstet Gynaecol. 2005;25:119–22.

    Article  CAS  PubMed  Google Scholar 

  17. Dias CS, Silva JM, Pereira AK, et al. Diagnostic accuracy of renal pelvic dilatation for detecting surgically managed ureteropelvic junction obstruction. J Urol. 2013;190:661–6.

    Article  PubMed  Google Scholar 

  18. O’Reilly PH, Brooman PJ, Mak S, Jones M, Pickup C, Atkinson C, Pollard AJ. The long-term results of Anderson–Hynes pyeloplasty. BJU Int. 2001;87(4):287–9.

    Article  PubMed  Google Scholar 

  19. Smith KE, Holmes N, Lieb JI, Mandell J, Baskin LS, Kogan BA, Walker RD 3rd. Stented versus nonstented pediatric Pyeloplasty: a modern series and review of the literature. J Urol. 2002;168(3):1127–30.

    Article  PubMed  Google Scholar 

  20. Gatti JM, Amstutz SP, Bowlin PR, Stephany HA, Murphy JP. Laparoscopic vs open Pyeloplasty in children: results of a randomized, prospective. Controlled Trial J Urol. 2017;197(3 Pt 1):792–7.

    PubMed  Google Scholar 

  21. Lopez PJ, Acuna C. Abdominal pain—urological aspects. In: Godbole P, Koyle M, Wilcox D, editors. Guide to pediatric urology and surgery in clinical practice. London: Springer; 2011. p. 157–64.

    Google Scholar 

  22. Polok M, Toczewski K, Borselle D, Apoznanski W, Jedrzejuk D, Patkowski D. Hydronephrosis in children caused by lower pole crossing vessels–how to choose the proper method of treatment? Front Pediatr. 2019;7:83.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Esposito C, Bleve C, Escolino M, Caione P, Gerocarni Nappo S, Farina A, Caprio MG, Cerulo M, La Manna A, Chiarenza SF. Laparoscopic transposition of lower pole crossing vessels (vascular hitch) in children with pelviureteric junction obstruction. Transl Pediatr. 2016;5(4):256–61.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER. Imaging studies after a first urinary tract infection in young children. N Engl J Med. 2003;348:195–202.

    Article  PubMed  Google Scholar 

  25. Giorgi LJ Jr, Bratslavsky G, Kogan BA. Febrile urinary tract infections in infants: renal ultrasound remains necessary. J Urol. 2005;173(2):568–70.

    Article  PubMed  Google Scholar 

  26. Samnakay N, Barker A. Urinary tract infections: Australasia. In: Godbole P, Koyle M, Wilcox D, editors. Guide to pediatric urology and surgery in clinical practice. London: Springer; 2011. p. 157–64.

    Google Scholar 

  27. Craig JC, Knight JF, Sureshkumar P, Lam A, Onikul E, Roy LP. Vesicoureteric reflux and timing of micturating cystourethrography after urinary tract infection. Arch Dis Child. 1997;76:275–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. McDonald A, Scranton M, Gillespie R, Mahajan V, Edwards GA. Voiding cystourethrogram and urinary tract infections: how long to wait? Pediatrics. 2000;105:E50.

    Article  CAS  PubMed  Google Scholar 

  29. McLellan DL, Retik AB, Bauer SB, et al. Rate and predictors of spontaneous resolution of prenatally diagnosed primary nonrefluxing megaureter. J Urol. 2002;168:2177–80.

    Article  PubMed  Google Scholar 

  30. Shokeir AA, Nijman RJM. Primary megaureter: current trends in diagnosis and treatment. BJU Int. 2000;86:861–8.

    Article  CAS  PubMed  Google Scholar 

  31. Bader M, McCarthy L. What is the efficacy of circumcision in boys with complex urinary tract abnormalities? Pediatr Nephrol. 2013;28(12):2267–72.

    Article  PubMed  Google Scholar 

  32. Jude E, Deshpande A, Barker A, Khosa J, Samnakay N. Intravesical ureteric reimplantation for primary obstructed megaureter in infants under 1 year of age. J Pediatr Urol. 2017;13(1):47.e1–7.

    Article  Google Scholar 

  33. Ortiz R, Parente A, Perez-Egido L, Burgos L, Angulo JM. Long-term outcomes in primary obstructive Megaureter treated by endoscopic balloon dilatation. Experience after 100 cases. Front Pediatr. 2018;6:275.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Doudt AD, Pusateri CR, Christman MS. Endoscopic Management of Primary obstructive megaureter: a systematic review. J Endourol. 2018;32(6):482–7.

    Article  PubMed  Google Scholar 

  35. Stein R, Rubenwolf P, Ziesel C, Kamal MM, Thüroff JW. Psoas hitch and Boari flap ureteroneocystostomy. BJU Int. 2013 Jul;112(1):137–55.

    Article  PubMed  Google Scholar 

  36. Kitchens DM, DeFoor W, Minevich E, Reddy P, Polsky E, McGregor A, Sheldon C. End cutaneous ureterostomy for the management of severe hydronephrosis. J Urol. 2007 Apr;177(4):1501–4.

    Article  PubMed  Google Scholar 

  37. Politano V, Leadbetter W. An operative technique for the correction of vesicoureteral reflux. J Urol. 2017;197(2):S94–S100. (Reprinted from J Urol, 79: 932–941, 1958)

    PubMed  Google Scholar 

  38. Steffens J, Stark E, Haben B, Treiyer A. Politano-Leadbetter ureteric reimplantation. BJU Int. 2006 Sep;98(3):695–712.

    Article  PubMed  Google Scholar 

  39. Lee PH, Diamond DA, Duffy PG, Ransley PG. Duplex reflux: a study of 105 children. J Urol. 1991;146:657.

    Article  CAS  PubMed  Google Scholar 

  40. Afshar K, Papanikolaou F, Malek R, Bagli D, Pippi-Salle JL, Khoury A. Vesicoureteral reflux and complete ureteral duplication. Conservative or surgical management? J Urol. 2005;173(5):1725–7.

    Article  PubMed  Google Scholar 

  41. Thomas JC. Vesicoureteral reflux and duplex systems. Adv Urol. 2008;2008:651891.

    Article  PubMed Central  Google Scholar 

  42. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child. 2005;90:853–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hensle TW, Reiley EA, Ritch C, Murphy A. The clinical utility and safety of the endoscopic treatment of vesicoureteral reflux in patients with duplex ureters. J Pediatr Urol. 2010;6(1):15–22.

    Article  CAS  PubMed  Google Scholar 

  44. Rossini CJ, Moriarty KP, Courtney RA, Tashjian DB. Endoscopic treatment with Deflux for refluxing duplex systems. J Laparoendosc Adv Surg Tech A. 2009;19(5):679–82.

    Article  PubMed  Google Scholar 

  45. Aboutaleb H, Bolduc S, Khoury AE, Upadhyay J, Bägli DJ, Farhat W. Polydimethylsiloxane injection versus open surgery for the treatment of vesicoureteral reflux in complete duplex systems. J Urol. 2003;170(4, Pt2):1563–5.

    Article  CAS  PubMed  Google Scholar 

  46. Ellsworth PI, Lim DJ, Walker RD, Stevens PS, Barraza MA, Mesrobian HGJ. Common sheath reimplantation yields excellent results in the treatment of vesicoureteral reflux in duplicated collecting systems. J Urol. 1996;155(4):1407–9.

    Article  CAS  PubMed  Google Scholar 

  47. Choi H, OH SJ. The management of children with complete ureteric duplication: selective use of uretero-ureterostomy as a primary and salvage procedure. BJU Int. 2000;86:508–12.

    Article  CAS  PubMed  Google Scholar 

  48. Hanson GR, Gatti JM, Gittes GK, Murphy JP. Diagnosis of ectopic ureter as a cause of urinary incontinence. J Pediatr Urol. 2007;3(1):53–7.

    Article  PubMed  Google Scholar 

  49. Peters CA, Mendelsohn C. Ectopic ureter, ureterocele, and ureteral anomalies. In Campbell-walsh urology, 12th ed. Published January 1; 2016. Ch 134, p. 3075–3101.e3.

    Google Scholar 

  50. Handler TF, Shapiro E. Incontinence in a child with a duplex kidney: case report. Rev Urol. 2002;4(Winter, 1):44–8.

    PubMed  PubMed Central  Google Scholar 

  51. Ortiz R, Parente A, Burgos L, Angulo JM. Endoscopic urinary diversion as initial Management of Symptomatic Obstructive Ectopic Ureter in infants. Front Pediatr. 2017;5:208.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Timberlake MD, Corbett ST. Minimally invasive techniques for management of the ureterocoele and ectopic ureter: upper tract versus lower tract approach. Urol Clin North Am. 2015;42(1):61–76.

    Article  PubMed  Google Scholar 

  53. McLeod DJ, Alpert SA, Ural Z, Jayanthi VR. Ureteroureterostomy irrespective of ureteral size or upper pole function: a single center experience. J Pediatr Urol. 2014;10(4):616–9.

    Article  CAS  PubMed  Google Scholar 

  54. Chacko JK, Koyle MA, Mingin GC, et al. Ipsilateral ureteroureterostomy in the surgical management of the severely dilated ureter in ureteral duplication. J Urol. 2007;178:1689–92.

    Article  PubMed  Google Scholar 

  55. Christensen T, Cohen D. Ureteral Obstruction and Malformations. In Ashcraft’s Paediatric Surgery, 5th ed. Eds Holcomb G and Murphy JP. 2009;6:307–15.

    Google Scholar 

  56. Castagnetti M, El-Ghoneimi A. Management of duplex system ureteroceles in neonates and infants. Nat Rev Urol. 2009;6:307–15.

    Article  PubMed  Google Scholar 

  57. Merlini E, Lelli CP. Obstructive ureterocele-an ongoing challenge. World J Urol. 2004;22(2):107–14.

    Article  CAS  PubMed  Google Scholar 

  58. Merguerian PA, Taenzer A, Knoerlein K, McQuiston L, Herz D. Variation in management of duplex system intravesical ureterocoeles: a survey of pediatric urologists. J Urol. 2010;184(4 Suppl):1625–30.

    Article  PubMed  Google Scholar 

  59. Adorisio O, Elia A, Landi L, et al. Effectiveness of primary endoscopic incision in treatment of ectopic ureterocele associated with duplex system. Urology. 2011;77:191–4.

    Article  PubMed  Google Scholar 

  60. Boucher A, Cloutier J, Rousseau A, Charrois R, Bolduc S. Is an initial endoscopic treatment for all ureteroceles appropriate? J Pediatr Urol. 2013;9:339–43.

    Article  PubMed  Google Scholar 

  61. Molitierno JA Jr, Scherz HC, Kirsch AJ. Endoscopic injection of dextranomer hyaluronic acid copolymer for the treatment of vesicoureteral reflux in duplex ureters. J Pediatr Urol. 2008;4:372–6.

    Article  PubMed  Google Scholar 

  62. You D, Bang JK, Shim M, Ryu DS, Kim SK. Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys. BJU Int. 2010;106:250–4.

    Article  PubMed  Google Scholar 

  63. Lee RS, Retik AB, Borer JG, et al. Pediatric retroperitoneal laparoscopic partial nephrectomy: comparison with an age matched cohort of open surgery. J Urol. 2005;174:708.

    Article  PubMed  Google Scholar 

  64. Leclair MD, Vidal I, Suply E, Podevin G, Heloury Y. Retroperitoneal laparoscopic heminephrectomy in duplex kidney in infants and children: a 15-year experience. Eur Urol. 2009;56(2):385–9.

    Article  PubMed  Google Scholar 

  65. Garcia-Aparicio L, Krauel L, Tarrado X, Olivares M, Garcia-Nunez B, Lerena J, Suara L, Rovira J, Rodo J. Heminephroureterectomy for duplex kidney: laparoscopy versus open surgery. J Pediatr Urol. 2010;6:157–60.

    Article  PubMed  Google Scholar 

  66. El-Ghoneimi A, Farhat W, Bolduc S, Bagli D, McLorie G, Khoury A. Retroperitoneal laparoscopic vs open partial nephroureterectomy in children. BJU Int. 2003;91:532–5.

    Article  CAS  PubMed  Google Scholar 

  67. Jayram G, Roberts J, Hernandez A, Heloury Y, Manoharan S, Godbole P, LeClair M, Mushtaq I, Gundeti MS. Outcomes and fate of the remnant moiety following laparoscopic heminephrectomy for duplex kidney: a multicenter review. J Pediatr Urol. 2011;7(3):272–5.

    Article  CAS  PubMed  Google Scholar 

  68. Murugapoopathy V, McCusker C, Gupta IR. The pathogenesis and management of renal scarring in children with vesicoureteric reflux and pyelonephritis. Pediatr Nephrol. 2019; https://doi.org/10.1007/s00467-018-4187-9.

  69. Edwards A, Peters CA. Managing vesicoureteral reflux in children: making sense of all the data. F1000Res. 2019;8:F1000 Faculty Rev-29.

    Google Scholar 

  70. Hoberman A, Trial Investigators RIVUR, Greenfield SP, Mattoo TK, et al. Antimicrobial prophylaxis for children with vesicoureteral reflux. N Engl J Med. 2014;370:2367–76.

    Article  PubMed  CAS  Google Scholar 

  71. Nagler EV, Williams G, Hodson EM, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev. 2011;6:CD001532.

    Google Scholar 

  72. Williams G, Hodson EM, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev. 2019;2:CD001532.

    PubMed  Google Scholar 

  73. Heidenreich A, Ozgur E, Becker T, Haupt G. Surgical management of vesicoureteral reflux in pediatric patients. World J Urol. 2004;22(2):96–106.

    Article  PubMed  Google Scholar 

  74. Tekgül S, Riedmiller H, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Stein R, Dogan HS. European Association of Urology. EAU guidelines on vesicoureteral reflux in children. Eur Urol. 2012;62(3):534–42.

    Article  PubMed  Google Scholar 

  75. Schwab CW, Wu HY, Selman H, Smith GH, Snyder HM, Canning DA. Spontaneous resolution of vesicoureteral reflux: a 15-year perspective. J Urol. 2002;168(6):2594–9.

    Article  PubMed  Google Scholar 

  76. Gucuk A, Burgu B, Gokce I, Mermerkaya M, Soygur T. Do antibiotic prophylaxis and/or circumcision change periurethral uropathogen colonization and urinary tract infection rates in boys with VUR? J Pediatr Urol. 2013;9(6 Pt B):1131–6.

    Article  PubMed  Google Scholar 

  77. Okarska-Napierała M, Wasilewska A, Kuchar E. Urinary tract infection in children: Diagnosis, treatment, imaging—comparison of current guidelines. J Pediatr Urol. 2017;13(6):567–73.

    Article  PubMed  Google Scholar 

  78. Stein R, Dogan HS, Hoebeke P, Kočvara R, Nijman RJ, Radmayr C, Tekgül S. Urinary tract infections in children: EAU/ESPU guidelines. Eur Urol. 2015;67(3):546–58.

    Article  PubMed  Google Scholar 

  79. National Institute for Health and Clinical Excellence NICE. Guideline on Urinary Tract Infection in Children. Urinary tract infection in under 16s: diagnosis and management. https://www.nice.org.uk/Guidance/cg54.

  80. Routh JC, Bogaert GA, Kaefer M, Manzoni G, Park JM, Retik AB, Rushton HG, Snodgrass WT, Wilcox DT. Vesicoureteral reflux: current trends in diagnosis, screening, and treatment. Eur Urol. 2012;61(4):773–82.

    Article  PubMed  Google Scholar 

  81. Elder JS, Diaz M, Caldamone AA, Cendron M, Greenfield S, Hurwitz R, Kirsch A, Koyle MA, Pope J, Shapiro E. Endoscopic therapy for vesicoureteral reflux: a meta-analysis, I: reflux resolution and urinary tract infection. J Urol. 2006;175:716–22.

    Article  PubMed  Google Scholar 

  82. Sillen U, Brandstrom P, Jodal U, et al. The Swedish reflux trial in children: V. bladder dysfunction. J Urol. 2010;184:298–304.

    Article  PubMed  Google Scholar 

  83. Sarhan OM, Alghanbar M, Alsulaihim A, Alharbi B, Alotay A, Nakshabandi Z. Multicystic dysplastic kidney: impact of imaging modality selection on the initial management and prognosis. J Pediatr Urol. 2014;10(4):645–9.

    Article  CAS  PubMed  Google Scholar 

  84. Tiryaki S, Alkac AY, Serdaroglu E, Bak M, Avanoglu A, Ulman I. Involution of multicystic dysplastic kidney: is it predictable? J Pediatr Urol. 2013 Jun;9(3):344–7.

    Article  PubMed  Google Scholar 

  85. Psooy K, Collaboration with the Pediatric Urologists of Canada (PUC). Multicystic dysplastic kidney (MCDK) in the neonate: the role of the urologist. Can Urol Assoc J. 2016;10(1–2):18–24.

    Article  PubMed  PubMed Central  Google Scholar 

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O’Brien, M. (2021). Upper Urinary Tract Obstruction. In: Godbole, P., Wilcox, D.T., Koyle, M.A. (eds) Practical Pediatric Urology. Springer, Cham. https://doi.org/10.1007/978-3-030-54020-3_9

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