TY - JOUR
T1 - Managing Ureteropelvic Junction Obstruction in the Young Infant
AU - Passoni, Niccolo Maria
AU - Peters, Craig Andrew
N1 - Publisher Copyright:
© Copyright © 2020 Passoni and Peters.
PY - 2020/5/27
Y1 - 2020/5/27
N2 - In the last decade, management of congenital UPJ obstruction has become progressively observational despite the lack of precise predictors of outcome. While it is clear that many children will have resolution of their hydronephrosis and healthy kidneys, it is equally clear that there are those in whom renal functional development is at risk. Surgical intervention for the young infant, under 6 months, has become relatively infrequent, yet can be necessary and poses unique challenges. This review will address the clinical evaluation of UPJO in the very young infant and approaches to determining in whom surgical intervention may be preferable, as well as surgical considerations for the small infant. There are some clinical scenarios where the need for intervention is readily apparent, such as the solitary kidney or in child with infection. In others, a careful evaluation and discussion with the family must be undertaken to identify the most appropriate course of care. Further, while minimally invasive pyeloplasty has become commonly performed, it is often withheld from those under 6 months. This review will discuss the key elements of that practice and offer a perspective of where minimally invasive pyeloplasty is of value in the small infant. The modern pediatric urologist must be aware of the various possible clinical situations that may be present with UPJO and feel comfortable in their decision-making and surgical care. Simply delaying an intervention until a child is bigger may not always be the best approach.
AB - In the last decade, management of congenital UPJ obstruction has become progressively observational despite the lack of precise predictors of outcome. While it is clear that many children will have resolution of their hydronephrosis and healthy kidneys, it is equally clear that there are those in whom renal functional development is at risk. Surgical intervention for the young infant, under 6 months, has become relatively infrequent, yet can be necessary and poses unique challenges. This review will address the clinical evaluation of UPJO in the very young infant and approaches to determining in whom surgical intervention may be preferable, as well as surgical considerations for the small infant. There are some clinical scenarios where the need for intervention is readily apparent, such as the solitary kidney or in child with infection. In others, a careful evaluation and discussion with the family must be undertaken to identify the most appropriate course of care. Further, while minimally invasive pyeloplasty has become commonly performed, it is often withheld from those under 6 months. This review will discuss the key elements of that practice and offer a perspective of where minimally invasive pyeloplasty is of value in the small infant. The modern pediatric urologist must be aware of the various possible clinical situations that may be present with UPJO and feel comfortable in their decision-making and surgical care. Simply delaying an intervention until a child is bigger may not always be the best approach.
KW - diuretic nephrogram
KW - infant–age
KW - prenatal hydronephrosis
KW - robotic assisted pyeloplasty
KW - ureteropelvic junction (UPJ) obstruction
UR - http://www.scopus.com/inward/record.url?scp=85086172410&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85086172410&partnerID=8YFLogxK
U2 - 10.3389/fped.2020.00242
DO - 10.3389/fped.2020.00242
M3 - Review article
C2 - 32537441
AN - SCOPUS:85086172410
SN - 2296-2360
VL - 8
JO - Frontiers in Pediatrics
JF - Frontiers in Pediatrics
M1 - 242
ER -