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Pyelo-ureteral junction obstruction in poorly functioning kidneys: Does conservative management play a role in

Angelo Zarfati1,2,3, Ermelinda Mele1,2, Maria Felicia Villani4

  • 1Pediatric Urology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Frontiers in Pediatrics
|April 10, 2023
PubMed

Insights

Conservative management for pediatric pyelo-ureteral junction obstruction (PUJO) in poorly functioning kidneys is controversial. Internal urinary diversion rarely improved kidney function, with no significant outcome differences between surgical and conservative approaches.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Surgical Outcomes

Background:

  • Management of pediatric pyelo-ureteral junction obstruction (PUJO) in kidneys with poor function remains debated, especially concerning conservative treatment options.
  • Limited differential renal function (DRF) in pediatric PUJO presents a challenge for treatment decisions.

Purpose of the Study:

  • To evaluate the outcomes of temporary internal urinary diversion in pediatric patients with UPJO affecting poorly functioning kidneys.
  • To assess the effectiveness of conservative versus surgical management following diversion in this patient cohort.

Main Methods:

  • Retrospective review of 17 pediatric patients with unilateral PUJO and DRF <20% undergoing temporary internal urinary diversion.
  • Assessment of DRF post-diversion, with subsequent management (conservative or surgical) based on clinical judgment and patient/family preference.

Main Results:

  • Only 4 of 17 patients (23%) experienced a significant DRF increase (≥5%) after diversion.
  • No significant differences in symptoms, need for further surgery, or renal function were observed between surgically and conservatively managed groups after a median follow-up of 3.1 years.
  • Overall, 53% of patients were managed surgically and 47% conservatively.

Conclusions:

  • Function recovery after internal urinary diversion in pediatric PUJO with severely impaired kidneys is uncommon.
  • This study suggests no significant difference in outcomes between surgical and conservative management strategies after diversion in this specific patient group.
Abstract

Keywords:
conservative treatmenthydronephrosisnephrectomypediatricpoorly functioning kidneyspyelo-ureteral junction obstructionpyeloplastysurgery

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