[Specificities of the treatment of abnormal pyelo-ureteral junction in children]

Area of Science:

• Pediatric Urology
• Surgical Innovation
• Congenital Abnormalities

Context:

• Prenatal ultrasound frequently detects ureteropelvic junction (UPJ) abnormalities in children.
• Pyeloplasty, a common procedure for UPJ obstruction, is typically performed on young infants.
• The posterior approach with the patient prone is the usual surgical position.

Purpose:

• To review current practices and ongoing debates in the surgical management of pediatric ureteropelvic junction obstruction.
• To discuss the indications and efficacy of different urinary pyelic drain types.
• To explore alternative surgical techniques for specific scenarios.

Summary:

• Resection-anastomosis pyeloplasty is the standard for UPJ obstruction in infants.
• The choice between simple nephrostomy and double J drain for urinary drainage remains a point of discussion.
• Ureteral-caliceal anastomosis is valuable for complex reoperations, especially with significant pyelocaliceal dilation.
• Laparoscopic surgery is beneficial for older children, while endopyelotomy shows promise for postoperative strictures.

Impact:

• Highlights the ongoing considerations in pediatric UPJ obstruction management.
• Provides insights into the comparative effectiveness of various surgical techniques and drainage methods.
• Informs clinical decision-making for pediatric urologists managing UPJ abnormalities.