A review of the difficult clinical scenarios associated with pelvi-ureteric junction obstruction in children: General guidelines in evaluation and management

Objectives: The aim of the study is to review the commonly encountered difficult clinical scenarios associated with pelvi-ureteric junction obstruction (PUJO) in children, identify the challenges, and outline the broad guidelines in the management of these cases. The classically employed sonological and biochemical criteria, both current and evolving, to assess the severity of PUJO are also reviewed. Material and Methods: A thorough review of literature was done for the guidelines and recommendations in the management of PUJO in children, especially the difficult clinical scenarios. This study focuses on the analysis of situations involving PUJO in children that presents challenges with regard to diagnosis, evaluation and therapy. These situations include scenarios ranging from non-obstructive renal pelvic dilatation and anatomical anomalies like duplex, to secondary PUJO and bilateral PUJO. A brief overview and summary of the common indications for surgery in PUJO is presented here. The current and evolving sonological, radiographic, and biochemical diagnostic criteria are also briefly reviewed here. Results: Judicious use of investigations to assess the entire urinary tract and studied interpretation of the findings will help to delineate the anomaly and its functional consequence. The most important aim is to establish the precise anatomical and functional status, to the greatest extent possible. This will help to guide therapy and predict outcome. Conclusion: The occasional difficult case scenarios associated with PUJO in children require greater understanding of the specific anatomical and physiological alterations, analysis of the particular pathology and its classical progression, targeted evaluation, and careful consideration of therapeutic options. The aim is to institute the most appropriate and timely therapy to salvage renal function and prevent progressive renal damage.