Pediatric Ureteropelvic Junction Obstruction Complicated with Ipsilateral Ureterovesical Junction Obstruction： Analysis of Diagnosis and Management in 14 Cases
10.11714/jsysu.med.YX20260035
- VernacularTitle:儿童肾盂输尿管连接部梗阻合并同侧输尿管膀胱连接部梗阻14例诊治分析
- Author:
Ye ZHANG
1
;
Wenting PEI
2
;
Qihang SUN
1
;
Jiabin JIANG
1
;
Yin ZHANG
1
;
Min CHAO
2
Author Information
1. Department of Urology，Anhui Provincial Children's Hospital， Hefei 230051， China
2. Department of Urology，Children's Medical Center of Anhui Medical University， Hefei 230051， China
- Publication Type:Journal Article
- Keywords:
pediatric patients;
ureteropelvic junction obstruction;
ureterovesical junction obstruction;
hydronephrosis;
surgical intervention
- From:
Journal of Sun Yat-sen University(Medical Sciences)
2026;47(4):715-721
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo investigate the clinical characteristics， diagnostic challenges， and treatment strategies in pediatric patients with ureteropelvic junction obstruction （UPJO） complicated with ipsilateral ureterovesical junction obstruction （UVJO）. MethodsA retrospective analysis was conducted on clinical data of pediatric patients admitted to our hospital between January 2014 and December 2024 with a confirmed diagnosis of UPJO complicated with UVJO. The collected clinical parameters included gender， age at presentation， initial diagnosis， lesion laterality， imaging findings， surgical procedures， and follow-up outcomes. ResultsThe study cohort comprised 14 pediatric patients （male=10 and female=4） with a median age of 3.1 months at presentation. The initial diagnoses were UPJO in 9 cases and UVJO in 5 cases. Preoperatively， only 6 cased showed ureteral dilation on MRU. The definitive diagnosis was confirmed by intraoperative retrograde pyelography in 5 cases， postoperative antegrade pyelography via a nephrostomy tube in 7 patients， and combined application of the two modalities in 2 patients. For primary surgical intervention， 9 patients underwent pyelo-plasty， 2 underwent ureteral reimplantation， 2 received percutaneous nephrostomy， and 1 underwent ureteral orifice dilation. Intraoperative nephrostomy tube placement was performed in 10 patients. With a median follow-up duration of 5.5 years， 4 patients required revision surgery. Of these， only 1 patient ， who had an initial diagnosis of UPJO， required staged management for persistent obstruction， whereas UPJ obstruction resolved after ureteroneocystostomy in the remaining 3 patients with an initial diagnosis of UVJO. Among the 10 patients who did not undergo revision surgery， 8 showed delayed distal urinary drainage on APG， yet remained asymptomatic with continuous improvement of hydronephrosis after nephrostomy tube clamping. ConclusionsPreoperative diagnosis of concurrent UPJO and ipsilateral UVJO in pediatric patients is clinically challenging. Further intraoperative evaluation is mandatory when antegrade or retrograde ureteral stent placement fails during surgery. For patients with an initial diagnosis of UPJO， pyeloplasty is the first-line treatment. Routine retrograde pyelography is not recommended， whereas nephrostomy tube with subsequent postoperative APG evaluation can prevent unnecessary ureteroneocystostomy. For patients with an initial diagnosis of UVJO accompanied by severe ureteral dilation， primary ureteroneocystostomy is feasible initial management strategy.
