Ureteropelvic junction obstruction: diagnosis and management

Area of Science:

• Pediatric Urology
• Diagnostic Imaging
• Nephrology

Background:

• Ureteropelvic junction obstruction (UPJO) is the leading cause of hydronephrosis detected prenatally.
• The natural history of UPJO is unpredictable, with outcomes ranging from spontaneous resolution to significant renal function loss.
• Current evaluation and treatment strategies for UPJO remain ill-defined.

Purpose of the Study:

• To review current literature on the prenatal and postnatal evaluation of infants with suspected UPJO.
• To highlight advancements in risk stratification and non-invasive diagnostic tools for UPJO.

Main Methods:

• Review of recent literature on prenatal and postnatal evaluation of hydronephrosis.
• Analysis of studies utilizing the urinary tract dilation (UTD) ultrasound classification system.
• Evaluation of magnetic resonance imaging (MRI) and urinary biomarker applications.

Main Results:

• The UTD classification system and MRI are emerging tools for risk stratification of infants with UPJO.
• Urinary biomarkers show promise as a non-invasive alternative to diuretic renography for identifying clinically significant UPJO.
• These advancements aid in predicting the need for surgery and potential renal impairment.

Conclusions:

• Novel approaches are improving the care of infants with UPJO.
• Further research is needed to establish definitive guidelines for UPJO evaluation and treatment.
• Long-term outcomes require better definition to optimize management strategies.