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. 2016 Jul 14;7(7):CD010716.
doi: 10.1002/14651858.CD010716.pub2.

Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in newborns and infants less than two years of age

Marcus Weitz  1 , Suniva Portz, Guido F Laube, Joerg J Meerpohl, Dirk Bassler
Affiliations

Surgery versus non-surgical management for unilateral ureteric-pelvic junction obstruction in newborns and infants less than two years of age

Marcus Weitz et al. Cochrane Database Syst Rev. .

Abstract

Background: Unilateral ureteric-pelvic junction obstruction (UPJO) is the most common cause of obstructive uropathy and may lead to renal impairment and loss of renal function. The current diagnostic approach with renal imaging cannot reliably determine which newborns and infants less than two years of age have a significant obstruction and are at risk for permanent kidney damage. There is therefore no consensus on optimal therapeutic management of unilateral UPJO.

Objectives: To assess the effects of surgical versus non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 6, 2016), MEDLINE/Ovid, and EMBASE/Ovid databases from their inception to 13 June 2016. We searched the reference lists of potentially relevant studies without using any language restriction. We also searched the following trial registers for relevant registered studies: www.clinicaltrials.gov/; ISRCTN registry (controlled-trials.com/); www.trialscentral.org/; apps.who.int/trialsearch/; www.drks.de/; and www.anzctr.org.au/trialSearch.aspx.

Selection criteria: We selected randomised and quasi-randomised controlled trials comparing surgical with non-surgical interventions for the treatment of unilateral UPJO.

Data collection and analysis: Two review authors independently assessed study eligibility and risk of bias of included studies and extracted data. In case of disagreements we consulted a third review author. The data reported in the two included studies did not allow us to perform a meta-analysis.

Main results: We found only two studies at high risk of bias that were eligible for inclusion in this review. The total sample size, including both trials, was small (n = 107 participants less than six months of age from the UK and USA), and not all prespecified outcome measures were assessed. Reported measures only accounted for the short-term follow-ups. The mean split renal function was not statistically different between the surgical and non-surgical group at the six-month or one-year time point (very low-quality evidence). The surgical group showed a significantly less obstructed drainage pattern and a lower urinary tract dilatation than the non-surgical group (very low-quality evidence). Transfer from the non-surgical group to the surgical group was reported for about one out of five participants. Split renal function after secondary surgical intervention was reported with variable results, but most of the participants reverted to pre-deteriorated values. The studies either provided no or insufficient data on the following outcome measures: postoperative complications, UPJO-associated clinical symptoms, costs of interventions, radiation exposure, quality of life, and adverse effects.

Authors' conclusions: We found limited evidence assessing the benefits and harms of surgical compared to non-surgical treatment options for newborns and infants less than two years of age with unilateral UPJO. The majority of participants in the non-surgical treatment group did not experience any significant deterioration of split renal function, and only about 20% of them underwent secondary surgical intervention, with minor risk of permanent deteriorated split renal function. The study follow-up period was too short to assess the long-term effects on split renal function in both treatment groups. We need further randomised controlled trials with sufficient statistical power and an adequate follow-up period to determine the optimal therapy for newborns and infants less than two years of age with unilateral UPJO.

PubMed Disclaimer

Conflict of interest statement

MW, SP, GFL, JJM, and DB: none known.

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Study flow diagram.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Dhillon 1998 {published data only}
    1. Dhillon HK. Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. British Journal of Urology 1998;81 Suppl 2:39‐44. - PubMed
Palmer 1998 {published data only}
    1. Palmer LS, Maizels M, Cartwright PC, Fernbach SK, Conway JJ. Surgery versus observation for managing obstructive grade 3 to 4 unilateral hydronephrosis: a report from the Society for Fetal Urology. Journal of Urology 1998;159(1):222‐8. - PubMed

References to studies excluded from this review

Heinlen 2009 {published data only}
    1. Heinlen JE, Manatt CS, Bright BC, Kropp BP, Campbell JB, Frimberger D. Operative versus nonoperative management of ureteropelvic junction obstruction in children. Urology 2009;73(3):521‐5; discussion 525. - PubMed

Additional references

Als‐Nielsen 2004
    1. Als‐Nielsen BE, Chen W, Gluud CN, Gluud LL. Are treatment effects or adverse effects of significance for the association between financing and conclusions in randomized trials?. Ugeskrift for Laeger 2004;166(18):1676‐8. - PubMed
Balshem 2011
    1. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. Journal of Clinical Epidemiology 2011;64(4):401‐6. - PubMed
Cerwinka 2010
    1. Cerwinka WH, Kirsch AJ. Magnetic resonance urography in pediatric urology. Current Opinion in Urology 2010;20(4):323‐9. [MEDLINE: ] - PubMed
Chen 2009
    1. Chen F. Genetic and developmental basis for urinary tract obstruction. Pediatric Nephrology (Berlin, Germany) 2009;24(9):1621‐32. [MEDLINE: ] - PMC - PubMed
Chevalier 2010
    1. Chevalier RL, Thornhill BA, Forbes MS, Kiley SC. Mechanisms of renal injury and progression of renal disease in congenital obstructive nephropathy. Pediatric Nephrology (Berlin, Germany) 2010;25(4):687‐97. [MEDLINE: ] - PubMed
Chou 2010
    1. Chou R, Aronson N, Atkins D, Ismaila AS, Santaguida P, Smith DH, et al. AHRQ series paper 4: assessing harms when comparing medical interventions: AHRQ and the Effective Health‐Care Program. Journal of Clinical Epidemiology 2010;63(5):502‐12. - PubMed
Clayton 2012
    1. Clayton DB, Brock JW 3rd. Prenatal ultrasound and urological anomalies. Pediatric Clinics of North America 2012;59(4):739‐56. [MEDLINE: ] - PubMed
Conway 1992
    1. Conway JJ, Maizels M. The "well tempered" diuretic renogram: a standard method to examine the asymptomatic neonate with hydronephrosis or hydroureteronephrosis. A report from combined meetings of the Society for Fetal Urology and members of the Pediatric Nuclear Medicine Council ‐ the Society of Nuclear Medicine. Journal of Nuclear Medicine 1992;33(11):2047‐51. - PubMed
Csaicsich 2004
    1. Csaicsich D, Greenbaum LA, Aufricht C. Upper urinary tract: when is obstruction obstruction?. Current Opinion in Urology 2004;14(4):213‐7. [MEDLINE: ] - PubMed
Davenport 2013
    1. Davenport MT, Merguerian PA, Koyle M. Antenatally diagnosed hydronephrosis: current postnatal management. Pediatric Surgery International 2013;29(3):207‐14. [MEDLINE: ] - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ (Clinical Research Ed.) 1997;315(7109):629‐34. - PMC - PubMed
Gallo 2009
    1. Gallo F, Schenone M, Giberti C. Ureteropelvic junction obstruction: which is the best treatment today?. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a 2009;19(5):657‐62. [MEDLINE: ] - PubMed
Gartlehner 2008
    1. Gartlehner G. Assessment of adverse effects and applicability ‐ two areas not (yet) covered adequately in Cochrane reports. Zeitschrift fur Evidenz, Fortbildung und Qualitat Im Gesundheitswesen 2008;102(8):497‐502. - PubMed
Guyatt 2011
    1. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction ‐ GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64(4):383‐94. - PubMed
Hampson 2012
    1. Hampson LA, Montie JE. Conflict of interest in urology. Journal of Urology 2012;187(6):1971‐7. - PubMed
Herndon 2009
    1. Herndon CDA, Kitchens DM. The management of ureteropelvic junction obstruction presenting with prenatal hydronephrosis. The Scientific World Journal 2009;9:400‐3. [MEDLINE: ] - PMC - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ (Clinical Research Ed.) 2003;327(7414):557‐60. [MEDLINE: ] - PMC - PubMed
Higgins 2011a
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Higgins 2011b
    1. Higgins JP, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hollis 1999
    1. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ (Clinical Research Ed.) 1999;319(7211):670‐4. - PMC - PubMed
Ingraham 2011
    1. Ingraham SE, McHugh KM. Current perspectives on congenital obstructive nephropathy. Pediatric Nephrology (Berlin, Germany) 2011;26(9):1453‐61. [MEDLINE: ] - PubMed
Jaffe 1980
    1. Jaffe RB, Middleton AW Jr. Whitaker test: differentiation of obstructive from nonobstructive uropathy. AJR. American Journal of Roentgenology 1980;134(1):9‐15. - PubMed
Karnak 2008
    1. Karnak I, Woo LL, Shah SN, Sirajuddin A, Kay R, Ross JH. Prenatally detected ureteropelvic junction obstruction: clinical features and associated urologic abnormalities. Pediatric Surgery International 2008; Vol. 24, issue 4:395‐402. [MEDLINE: ] - PubMed
King 1984
    1. King R, Coughlin PW, Bloch EC, Bowie JD, Ansong K, Hanna M. The case for immediate pyeloplasty in the neonate with ureteropelvic junction obstruction. Journal of Urology 1984;132(4):725‐8. [MEDLINE: ] - PubMed
Koff 2008
    1. Koff SA. Requirements for accurately diagnosing chronic partial upper urinary tract obstruction in children with hydronephrosis. Pediatric Radiology 2008;38(Suppl 1):S41‐8. [MEDLINE: ] - PubMed
Malki 2012
    1. Malki M, Linton KD, Mackinnon R, Hall J. Conservative management of pelvi‐ureteric junction obstruction (PUJO): is it appropriate and if so what duration of follow‐up is needed?. BJU International 2012;110(3):446‐8. [MEDLINE: ] - PubMed
Meerpohl 2010
    1. Meerpohl JJ, Wolff RF, Niemeyer CM, Antes G, Elm E. Editorial policies of pediatric journals: survey of instructions for authors. Archives of Pediatrics & Adolescent Medicine 2010;164(3):268‐72. - PubMed
Mei 2011
    1. Mei H, Pu J, Yang C, Zhang H, Zheng L, Tong Q. Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta‐analysis. Journal of Endourology/Endourological Society 2011;25(5):727‐36. [MEDLINE: ] - PubMed
Mesrobian 2010
    1. Mesrobian HG, Mitchell ME, See WA, Halligan BD, Carlson BE, Greene AS, et al. Candidate urinary biomarker discovery in ureteropelvic junction obstruction: a proteomic approach. Journal of Urology 2010;184(2):709‐14. [MEDLINE: ] - PubMed
Mesrobian 2012
    1. Mesrobian HG, Mirza SP. Hydronephrosis: a view from the inside. Pediatric Clinics of North America 2012;59(4):839‐51. [MEDLINE: ] - PubMed
Moher 1998
    1. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta‐analyses?. The Lancet 1998;352(9128):609‐13. - PubMed
Muthusami 2013
    1. Muthusami P, Bhuvaneswari V, Elangovan S, Dorairajan LN, Ramesh A. The role of static magnetic resonance urography in the evaluation of obstructive uropathy. Urology 2013;81(3):623‐8. [MEDLINE: ] - PubMed
NAPRTC 2008
    1. North American Pediatric Renal Trials and Collaborative Studies. NAPRTCS 2008 Annual Report: Renal transplantation, dialysis, chronic renal insufficiency. https://web.emmes.com/study/ped/annlrept/Annual%20Report%20‐2008.pdf (accessed 6 August 2013).
Nguyen 2010
    1. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. Journal of Pediatric Urology 2010; Vol. 6, issue 3:212‐31. [MEDLINE: ] - PubMed
Perez 1991
    1. Perez LM, Friedman RM, King LR. The case for relief of ureteropelvic junction obstruction in neonates and young children at time of diagnosis. Urology 1991;38(3):195‐201. [MEDLINE: ] - PubMed
Pildal 2007
    1. Pildal J, Hróbjartsson A, Jørgensen KJ, Hilden J, Altman DG, Gøtzsche PC. Impact of allocation concealment on conclusions drawn from meta‐analyses of randomized trials. International Journal of Epidemiology 2007;36(4):847‐57. - PubMed
Ramm 2012
    1. Ramm O, Brubaker L. Conflicts‐of‐interest disclosures at the 2010 AUGS Scientific Meeting. Female Pelvic Medicine & Reconstructive Surgery 2012;18(2):79‐81. - PubMed
Ransley 1990
    1. Ransley PG, Dhillon HK, Gordon I, Duffy PG, Dillon MJ, Barratt TM. The postnatal management of hydronephrosis diagnosed by prenatal ultrasound. Journal of Urology 1990;144(2 Pt 2):584‐7; discussion 593‐4. [MEDLINE: ] - PubMed
Riccabona 2009
    1. Riccabona M, Avni FE, Blickman JG, Dacher JN, Darge K, Lobo ML, et al. Imaging recommendations in paediatric uroradiology. Minutes of the ESPR uroradiology task force session on childhood obstructive uropathy, high‐grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. ESPR Annual Congress, Edinburgh, UK, June 2008. Pediatric Radiology 2009;39(8):891‐8. [MEDLINE: ] - PubMed
Rosen 2008
    1. Rosen S, Peters CA, Chevalier RL, Huang WY. The kidney in congenital ureteropelvic junction obstruction: a spectrum from normal to nephrectomy. Journal of Urology 2008;179(4):1257‐63. [MEDLINE: ] - PubMed
Schulz 1995
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408‐12. - PubMed
Schulz 2010
    1. Schulz KF, Altman DG, Moher D, Group Consort. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. Journal of Clinical Epidemiology 2010;63:834‐40. - PubMed
Sutherland 1997
    1. Sutherland RW, Chung SK, Roth DR, Gonzales ET. Pediatric pyeloplasty: outcome analysis based on patient age and surgical technique. Urology 1997; Vol. 50, issue 6:963‐6. [MEDLINE: ] - PubMed
Thornhill 2007
    1. Thornhill BA, Forbes MS, Marcinko ES, Chevalier RL. Glomerulotubular disconnection in neonatal mice after relief of partial ureteral obstruction. Kidney International 2007;72(9):1103‐12. [MEDLINE: ] - PubMed
Vaughan 2004
    1. Vaughan ED Jr, Marion D, Poppas DP, Felsen D. Pathophysiology of unilateral ureteral obstruction: studies from Charlottesville to New York. Journal of Urology 2004;172(6 Pt 2):2563‐9. [MEDLINE: ] - PubMed
Weikert 2005
    1. Weikert S, Christoph F, Muller M, Schostak M, Miller K, Schrader M. Acucise endopyelotomy: a technique with limited efficacy for primary ureteropelvic junction obstruction in adults. International Journal of Urology 2005;12(10):864‐8. [MEDLINE: ] - PubMed
Weitz 2013
    1. Weitz M, Tschumi S, Bassler D. Surgery versus non‐surgical management for unilateral ureteric‐pelvic junction obstruction in children. Cochrane Database of Systematic Reviews 2013, Issue 8. [DOI: 10.1002/14651858.CD010716] - DOI - PMC - PubMed
Williams 2007
    1. Williams B, Tareen B, Resnick MI. Pathophysiology and treatment of ureteropelvic junction obstruction. Current Urology Reports 2007;8(2):111‐7. [MEDLINE: ] - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Juni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta‐epidemiological study. BMJ (Clinical Research Ed.) 2008;336(7644):601‐5. - PMC - PubMed

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