Prasad Gaurav, Agarwal Keshav, Gulia Annu, Pakkasjärvi Niklas, Ranjan Abhishek, Jana Manisha, Yadav Devendra Kumar, Anand Sachit
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
J Indian Assoc Pediatr Surg. 2025 Sep-Oct;30(5):569-575. doi: 10.4103/jiaps.jiaps_72_25. Epub 2025 Jun 2.
Ureteropelvic junction obstruction (UPJO) is a common cause of pediatric hydronephrosis, yet only one-third of affected children require surgery. Differentiating obstructive from non-obstructive cases remains challenging with current imaging methods. This systematic review and meta-analysis evaluated the role of ureteric jets, assessed via color Doppler ultrasonography (USG), as an adjuvant diagnostic modality to complement gray-scale USG in children with UPJO.
A systematic search of PubMed, Embase, Scopus, and Web of Science databases was conducted to identify studies reporting on ureteric jet frequency (UJF) in UPJO. Standardized mean difference (SMD) with 95% confidence intervals (CI) was calculated for the pooled data, while the ² statistic assessed heterogeneity. Methodological quality was evaluated using the Newcastle-Ottawa scale.
Five studies (111 patients) met inclusion criteria. Ureteric jets were absent in 67.3% of UPJO cases, with diagnostic accuracy reaching 94%. Meta-analysis revealed a significant reduction in UJF in obstructed kidneys (SMD = -2.01, 95% CI: -3.09 to -0.94, = 0.0002), though heterogeneity was substantial (² = 80%, = 0.006). The methodological quality of the included studies was good in four studies and poor in one study.
The current systematic review demonstrated the absence of ureteric jets and a significant reduction in the UJF in the obstructed kidneys. However, due to heterogeneity among the included studies, further studies are needed to standardize the protocols before any definite conclusions are drawn.
肾盂输尿管连接处梗阻（UPJO）是小儿肾积水的常见原因，但只有三分之一的患病儿童需要手术治疗。目前的影像学方法在区分梗阻性与非梗阻性病例方面仍然具有挑战性。本系统评价和荟萃分析评估了通过彩色多普勒超声（USG）评估的输尿管喷流作为辅助诊断手段，以补充UPJO患儿灰阶USG的作用。
对PubMed、Embase、Scopus和Web of Science数据库进行系统检索，以确定报告UPJO中输尿管喷流频率（UJF）的研究。计算合并数据的标准化均数差（SMD）及95%置信区间（CI），同时用I²统计量评估异质性。使用纽卡斯尔-渥太华量表评估方法学质量。
五项研究（111例患者）符合纳入标准。67.3%的UPJO病例中无输尿管喷流，诊断准确率达94%。荟萃分析显示梗阻性肾脏的UJF显著降低（SMD = -2.01，95% CI：-3.至-0.94，P = 0.0002），尽管异质性较大（I² = 80%，P = 0.006）。纳入研究中有四项研究的方法学质量良好，一项研究较差。
当前的系统评价表明梗阻性肾脏无输尿管喷流且UJF显著降低。然而，由于纳入研究之间存在异质性，在得出任何明确结论之前，需要进一步研究来规范方案。
