Co-Existing Pediatric Ureteropelvic Junction Obstruction and Vesicoureteric Reflux: Prevalence and Implications

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Outcomes

Background:

• Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in children.
• Vesicoureteric reflux (VUR) is a condition where urine flows backward from the bladder to the kidneys.
• The coexistence of UPJO and VUR can complicate management and affect renal outcomes.

Purpose of the Study:

• To determine the prevalence of ipsilateral VUR in children with UPJO.
• To compare the outcomes of pyeloplasty in patients with and without associated VUR.
• To identify factors influencing post-pyeloplasty results in the presence of VUR.

Main Methods:

• A prospective study included 135 children undergoing pyeloplasty between 2014 and 2016.
• Patients were divided into two groups: Group 1 (UPJO without VUR) and Group 2 (UPJO with ipsilateral VUR).
• Data on patient demographics, preoperative renal function, and postoperative outcomes were compared.

Main Results:

• Ipsilateral VUR was present in 25.9% of patients (35/135).
• Infants (<1 year) constituted a higher proportion of patients with VUR (31/35).
• Patients with VUR showed significantly less preoperative differential renal function (in children >1 year) and a higher incidence of renal scars and pyelonephritic changes at 1-year follow-up.
• While both groups improved post-pyeloplasty, Group 1 demonstrated better drainage improvement at 3 months and between 3 months and 1 year.

Conclusions:

• The prevalence of VUR in conjunction with UPJO is significant, particularly in infants.
• Associated VUR can lead to diminished renal function and delayed urinary drainage post-pyeloplasty.
• A preoperative voiding cystourethrogram is recommended for children under 1 year with UPJO to detect and manage concurrent VUR, thereby preserving renal function.