Diagnosing ureteropelvic junction obstruction in pediatrics: A systematic review
Stanley Wong1, Thomas Ying2, Dawn L. MacLellan3, Rodrigo Romao3, Luis Braga4, Melise Keays5.
1Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; 2Department of Urology, The Ottawa Hospital, Ottawa, ON, Canada; 3Department of Urology, Dalhousie University, Halifax, NS, Canada; 4Division of Urology, McMaster University, Hamilton, ON, Canada; 5Department of Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
Pediatric Urologists of Canada Research Collaborative.
Introduction: The concept of pediatric ureteropelvic junction obstruction (UPJO), or suspected UPJO, represents a heterogenous population with various modes of presentation, as well as varying degrees of obstruction with differential risk of renal deterioration or development of symptoms if left uncorrected. We hypothesized that the current published literature lacks consistency in reporting and aimed to perform a systematic review of reported diagnostic criteria for pediatric UPJO and indications for pyeloplasty.
Methods: We conducted a MEDLINE and EMBASE search from 1980–2019 using key MESH search terms for UPJO with Child and Prognosis filter. Clinical studies including at least five children with any description of UPJO diagnostic criteria or indications for surgery were included. Non-clinical, abstracts, and conference proceedings were excluded, as were conditions with confounding diagnoses. Abstract and expedited full-text review was performed using Insight Scope platform. Qualitative analysis of verbatim definition of UPJO diagnostic criteria and indication for surgery allowed for extraction of all reported diagnostic items and categorization into themes and frequencies reported.
Results: Two hundred eleven of 1580 studies were included for data extraction; 77% were retrospective studies, 19% prospective studies, 3% systematic reviews, 1% others. A total of 972 diagnostic items were extracted. Major reported domains are summarized in Table 1. Major categories for diagnosis of UPJO or indications for pyeloplasty included findings on ultrasound (97%), Lasix renal scan (94%), and symptoms (47%). Only 44% of papers reported all three major domains. Indications for pyeloplasty were reported in 118 studies (56% of total).
Conclusions: There is heterogeneity in the reporting of diagnostic criteria, as well as indication, for pyeloplasty for pediatric UPJO. Future work to develop and adopt standard reporting criteria for UPJO diagnosis and indications for pyeloplasty could advance the field by allowing comparison of different studies.
