Eosinophilic pelvi-ureteritis is an uncommon inflammatory condition characterised by eosinophil infiltration in the urinary tract, which can lead to varied clinical presentations ranging from urinary obstruction to reflux. Here, we report the case of a boy in early childhood initially diagnosed with right-sided pelvi-ureteric junction (PUJ) obstruction (PUJO) presenting as an abdominal lump with gross hydronephrosis. The patient underwent laparoscopic pyeloplasty over a double-J stent. Postoperatively, the patient exhibited features of recurrent PUJO after stent removal. The patient was taken up for redo-laparoscopic pyeloplasty, and intraoperatively, a polypoidal growth was identified obstructing the PUJ, which, on histopathological analysis, revealed eosinophilic infiltration. Laboratory evaluation showed peripheral eosinophilia. Medical management with corticosteroids, antihistamines and antihelminthics was initiated. At 1-year follow-up, the patient was asymptomatic with preserved renal function. This case highlights eosinophilic pelvi-ureteritis as a rare cause of recurrent PUJO and underscores the importance of a combined surgical and medical approach for effective management.

Purpose: There has been a longstanding debate regarding whether lower pole renal crossing vessels on the pelvi-ureteric junction preclude the need for a dismembered pyeloplasty. A retroperitoneoscopic technique for a transposition of these vessels has not yet been described in the literature. We report our early experience of the retroperitoneoscopic vascular hitch procedure for transposition of lower pole renal crossing vessels, including technique and outcomes. Methods: Single-center retrospective review of all children who had a retroperitoneoscopic vascular hitch procedure for pelvi-ureteric junction obstruction from March 2022 to April 2024. Data on symptom resolution, change in sonographic anterior-posterior diameter (APD), MAG-3 (mercaptoacetyltriglycine) renogram curves, postoperative length of stay, complications, and further surgical interventions were collected. Results are reported as median and interquartile range. Results: Ten patients (70% male, median age 11.7 years, range 8-13 years) with preoperative APD of 34 mm (23-40) over the 2-year period were included. One patient received an on-table diuretic stress test. Seven out of 10 patients had day-case surgery, and 3 patients had an overnight stay. The follow-up period was 343 days (122-456). Postoperative APD was 13 mm (6-23), and the change in APD was -18 mm (-25 to -10). No loss of function or uptake areas on MAG-3 scans were observed. Two patients received antibiotics for a presumed urinary tract infection in the postoperative period. Symptom resolution was achieved in 90% of patients, and 1 patient underwent robotic-assisted dismembered pyeloplasty 10 months later. Conclusion: Retroperitoneoscopic vascular hitch for lower pole renal crossing vessels is an acceptable alternative to dismembered pyeloplasty in selected pediatric cases.

Ureteropelvic junction obstruction (UPJO), characterised by prenatal or postnatal renal pelvis dilation, represents the primary cause of congenital paediatric hydronephrosis. UPJO may lead to impaired renal function in paediatric patients. Its pathogenesis includes genetic predisposition and anatomical abnormalities. While spontaneous resolution may occur in some infants, progressive hydronephrosis can lead to renal impairment without intervention. The assessment of the degree of hydronephrosis, renal dysfunction and surgical indications in paediatric patients before surgery is beneficial for providing doctors with surgical decisions. Pyeloplasty remains the gold-standard surgical intervention. Surgical approach selection, such as minimally invasive or open surgery and drainage method during surgery, directly affects outcomes. Many factors can affect postoperative complications and reoperation. Postoperative prognostic evaluation and renal function prediction remain key clinical focuses. Long-term follow-up data can provide significant clinical value. The application of neural network prediction models in this field still needs to be explored. This review aims to explore the update progress on risk prediction models of UPJO for children mainly over the past decade. We analysed various risk factors before, during and after surgery, intending to construct risk prediction models that cover the entire disease cycle in diagnosis and treatment. This review could provide a practical basis for surgeons to make clinical decisions.

There are few realistic and accessible laparoscopic pyeloplasty training models. The aim of this study is to develop a functional training model through user-centered design that depicts the pathological features of pelvicoureteric junction obstruction (PUJO). Realistic patient-matched anatomical models of the kidney, renal pelvis, and ureter were created based on segmentations of computed tomography (CT) scans of a paediatric patient with PUJO who underwent laparoscopic pyeloplasty. Three training model versions (polyjet, resin, and silicone) were produced, tested, and published. Training model testing was conducted by consultant surgeons (n = 14), training surgeons (n = 5), and medical students (n = 8). Face validity testing was conducted to assess realism and usefulness of training models on a 10-point Likert-type scale. Training model accessibility was assessed using equipment availability and cost to set-up and produce as proxy measures. Participants significantly preferred polyjet and silicone models over resin models for overall rating (6.9 ± 2.3, 7.9 ± 1.1, and 5.0 ± 1.8) respectively; and usefulness in trainees (7.6 ± 2.1, 8.6 ± 0.9, and 5.0 ± 3.1) respectively. While both the polyjet and silicone models were found to be realistic and useful, the silicone model is considered more accessible due to the ready availability of the manufacturing equipment and materials and around 300-fold reduction in cost compared to polyjet. A surgeon-assessed realistic and useful pyeloplasty surgical training model was developed here which enables surgical practice on challenging small anatomical features. The comparatively low cost and accessibility of the silicone model can enable trainees to practice the procedure depicting the realistic pathological features in environments with limited resources.

Pelvi-Ureteric Junction Obstruction (PUJO) is a common cause of hydronephrosis (HDN) in children. While ultrasonography (USG) is useful for initial assessment and grading of hydronephrosis, it cannot differentiate obstructive from non-obstructive cases. Renal Dynamic Scintigraphy (RDS) confirms the diagnosis but involves ionizing radiation exposure. Ureteric jets using colour Doppler USG have been proposed for diagnosing obstructive HDN. Our study aimed to evaluate Ureteric Jet Frequency (UJF) and Relative Jet Frequency (RJF) in unilateral PUJO before and after furosemide (Lasix) administration, assessing their diagnostic and post-operative utility. Children (<14 years) with unilateral HDN underwent USG and RDS for PUJO diagnosis. Pyeloplasty was performed based on standard criteria. UJF and RJF were assessed before and after furosemide administration (0.5 mg/kg) by colour Doppler USG. The non-obstructed side was taken as the control. Follow-up included repeat RDS and ureteric jet assessment. Fifty-two cases were included. UJF (pre- and post-Lasix) was significantly lower in the obstructed side compared to the non-obstructed side at baseline and post-pyeloplasty (p < 0.0001). However, the baseline UJF difference between cases and controls was not significant (p > 0.05). UJF and RJF (pre- and post-Lasix) increased postoperatively. The UJF difference decreased postoperatively (p < 0.05). (attached Table) CONCLUSION: UJF and RJF are useful for diagnosing and monitoring unilateral PUJO. The effect of furosemide on UJF needs to be assessed using additional studies with larger sample sizes to understand if it can affect UJF in a way similar to that noted in diuretic scintigraphy.