title: Primary non-surgical management of unilateral ureteropelvic junction obstruction in children: a systematic review.
abstract: Ureteropelvic junction obstruction (UPJO) is the most common obstructive uropathy and its optimal management remains controversial. However, there is a current trend towards non-surgical management. We aimed to determine the effects of the non-surgical management in children with unilateral UPJO. For a systematic review, we searched MEDLINE, EMBASE, CENTRAL, clinical trials registries, and selected conference proceedings for eligible studies. Any type of study reporting the outcomes renal function, secondary surgical intervention, drainage pattern or hydronephrosis of non-surgical management in children with unilateral UPJO was included. Data from 20 studies were extracted and evaluated by two independent authors. The pooled prevalence was 21% for split renal function deterioration, 27.9% for secondary surgical intervention, 3.2% for progressive hydronephrosis, and 82.2% for improved drainage pattern. Not all patients with surgical intervention regained split renal function from enrolment. Renal imaging methods did not strongly correlate with each other. Many studies had to be excluded because of a lack of detection of an obstruction or mixed populations with bilateral UPJO or other uropathies. The variable definitions of UPJO, different criteria for surgical intervention, incongruity of management protocols, and the imprecise reporting of outcomes were limiting factors in the comparability of the results, leading to heterogeneity in meta-analyses. Although the available evidence cannot recommend or refute the current non-surgical management, the systematic review clarifies aspects of the ongoing controversy by providing realistic estimates for non-surgical management in children with unilateral UPJO. Additionally, it reveals unclear potential risks, particularly for long-term outcomes, which were rarely reported.
authors.affiliation: Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. marcus.weitz@kispi.uzh.ch.
authors.forename: Marcus
authors.initials: M
authors.lastname: Weitz
authors.affiliation: Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Nephrology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
authors.forename: Guido
authors.initials: G
authors.lastname: Laube
mesh_terms: D002648:Child; D004322:Drainage / Q000379:methods; D006801:Humans; D006869:Hydronephrosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D007668:Kidney / Q000503:physiopathology*; D007682:Kidney Pelvis / Q000473:pathology*; D014517:Ureteral Obstruction / Q000150:complications / Q000628:therapy*
keywords: Children; Hydronephrosis; Management; Renal function; Ureteropelvic junction obstruction