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

Pediatr Surg Int. 2023 Mar 7;39(1):147. doi: 10.1007/s00383-023-05434-w.


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.

Keywords: Hydronephrosis; UPJO; Ureteropelvic junction obstruction.

MeSH terms

  • Child
  • Conservative Treatment
  • Female
  • Humans
  • Hydronephrosis* / etiology
  • Hydronephrosis* / surgery
  • Hypertension*
  • Infant
  • Kidney
  • Male
  • Pregnancy
  • Retrospective Studies