Diagnosis and management of concurrent ureteropelvic and ureterovesical junction obstructions in children

Abstract

Objective To report our experience of diagnosing and treating coexisting ureteropelvic junction obstruction (UPJO) & ureterovesical junction obstruction (UVJO) in pediatric patients. Methods We searched for pediatric patients with coexisting UPJO & UVJO between January 2012 to July 2015. Ultrasonography, diuretic renography and voiding cystourethrography were performed preoperatively. Results There were 43 pediatric patients with coexisting UPJO & UVJO. Two patients were lost to follow-up. The correct diagnosis was made preoperatively in 11 patients. Pyeloplasty was the initial surgical option for 41 patients. Among 41 patients undergoing initial pyeloplasty, additional ureteroneocystostomy was required in 28. Renal function of 3 cases was less than 5% after initial pyeloplasty and renal resection performed. Function and morphology of hydronephrotic kidneys were restored significantly in other patients. Conclusions It is often difficult to correctly diagnose coexisting UPJO and UVJO. Examinations should be carefully checked to avoid the omission of coexisting pathological changes. A definite diagnosis should be made through necessary preoperative imaging examinations. Then satisfactory outcomes may be obtained by individualized treatment plan. Initial pyeloplasty should be chosen if there is a clear diagnosis of UPJO before operation. Ureteroneocystostomy should be performed according to the results of examination. Key words: Kidney; Hydronephrosis; Ureteropelvic junction obstruction; Ureterovesical junction obstruction