Utility of Ureteric Jets as an Adjuvant Diagnostic Modality in Children with Ureteropelvic Junction Obstruction: A Systematic Review and Meta-analysis

Abstract

<p>Background: 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. <br></p><p>Materials and Methods: 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 I² statistic assessed heterogeneity. Methodological quality was evaluated using the Newcastle-Ottawa scale. Results: 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, P = 0.0002), though heterogeneity was substantial (I² = 80%, P = 0.006). The methodological quality of the included studies was good in four studies and poor in one study. Conclusions: The current systematic review demonstrated the absence of ureteric jets and a significant<br></p><p> 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.</p>