Journal of pediatric surgery · 2026
Coexisting pelviureteric and vesicoureteric junction obstruction in children: Diagnostic challenges and treatment strategies - A narrative review.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Shajini Nirmalan, Babu Ramesh
Аннотация
BACKGROUND: Coexistent pelviureteric junction obstruction (PUJO) and vesicoureteric junction obstruction (VUJO) is uncommon and presents significant diagnostic and therapeutic dilemma. We conducted a narrative review to synthesize contemporary evidence in management.
METHODS: A comprehensive search of PubMed, Embase, and Cochrane databases was performed for English-language studies (2000-2024) reporting paediatric cohorts with concurrent PUJO and VUJO. Two reviewers independently screened records and extracted data regarding diagnostic strategies, initial interventions and the requirement for secondary procedures in renal-units. Risk of bias was assessed using the ROBINS-I tool. Due to the rarity of this condition and the limited number of heterogeneous studies, quantitative analysis was exploratory and focused on descriptive statistics (proportions and 95% confidence intervals) to generate hypotheses.
RESULTS: Of the 734 records screened, six studies met the inclusion criteria. Significant heterogeneity was observed in preoperative imaging and intraoperative assessment protocols. Only two authors compared PUJO-first and VUJO-first management: reoperation for unaddressed distal obstruction occurred in 6/23 (26%, 95% CI: 12-47%) of former approach while repeat pyeloplasty occurred in 3/6 (50%, 95% CI: 19-81%) renal-units in later approach.
CONCLUSIONS: Synchronous occurrence of PUJO and VUJO is rare and management should be individualized and sequential targeting the site with the predominant obstruction. Discordant findings between ultrasound and renogram could act as red-flag for suspecting dual obstruction. Selective intraoperative RGP is recommended in those with suspected dual obstruction. Simultaneous pyeloplasty and ureteral reimplantation in a single setting is discouraged. Further larger multi-centre studies on dual obstruction are warranted.
PROSPERO REGISTRATION NUMBER: CRD420261299538.
METHODS: A comprehensive search of PubMed, Embase, and Cochrane databases was performed for English-language studies (2000-2024) reporting paediatric cohorts with concurrent PUJO and VUJO. Two reviewers independently screened records and extracted data regarding diagnostic strategies, initial interventions and the requirement for secondary procedures in renal-units. Risk of bias was assessed using the ROBINS-I tool. Due to the rarity of this condition and the limited number of heterogeneous studies, quantitative analysis was exploratory and focused on descriptive statistics (proportions and 95% confidence intervals) to generate hypotheses.
RESULTS: Of the 734 records screened, six studies met the inclusion criteria. Significant heterogeneity was observed in preoperative imaging and intraoperative assessment protocols. Only two authors compared PUJO-first and VUJO-first management: reoperation for unaddressed distal obstruction occurred in 6/23 (26%, 95% CI: 12-47%) of former approach while repeat pyeloplasty occurred in 3/6 (50%, 95% CI: 19-81%) renal-units in later approach.
CONCLUSIONS: Synchronous occurrence of PUJO and VUJO is rare and management should be individualized and sequential targeting the site with the predominant obstruction. Discordant findings between ultrasound and renogram could act as red-flag for suspecting dual obstruction. Selective intraoperative RGP is recommended in those with suspected dual obstruction. Simultaneous pyeloplasty and ureteral reimplantation in a single setting is discouraged. Further larger multi-centre studies on dual obstruction are warranted.
PROSPERO REGISTRATION NUMBER: CRD420261299538.