Obstructive Uropathies: Epidemiological Features and Diagnostic Approaches in Dakar

Abstract

Introduction: Obstructive uropathies refer to anatomical impediments to normal urinary flow. They are predominantly caused by congenital malformations of the urinary tract and occasionally complicated by obstructive urinary stones. This study aims to elucidate the epidemiological and diagnostic facets of obstructive uropathies. Patients and Method: This retrospective, descriptive study was conducted over six years, from January 1, 2018, to December 31, 2023, at the pediatric surgery department of Albert Royer Children’s Hospital in Dakar, Senegal. The study focused on the frequency of obstructive uropathies, the sex ratio, discovery contexts, types and locations of uropathies, and associated malformations. Results: Among the 29,935 children received in the department during the study period, 130 cases of obstructive uropathies were documented, equating to a hospital incidence of 0.43%. The mean age of patients was 42.53 months, ranging from one day to 15 years. Infants constituted the largest affected group, at 47.69%. The cohort included 106 males and 24 females, rendering a sex ratio of 4.41. The antenatal diagnosis was confirmed in 27 patients (20%). Uretero-hydronephrosis emerged as the predominant clinical indication. Postnatally, urinary disorders prompted consultation in 36% of cases. Ultrasound examinations were performed universally. Additionally, VUCG was conducted in 49% of patients to identify lower urinary tract obstructions, while 39% underwent urological CT scan for upper tract obstruction etiology. Renal distress with electrolyte imbalance was evident in 8% of cases. Concurrent urogenital pathologies were present in 18% of cases. Notably, posterior urethral valves accounted for 39%, pyeloureteric junction obstruction for 31%, obstructive caliceal and pelvic lithiasis at 8%, and obstructive ureteral lithiasis at 6%. Other obstruction causes included obstructive megaureter on simple systems (3%), ectopic ureter in duplex systems (2%), urethral stenosis (2%), obstructive urethral lithiasis (2%), obstructive bladder lithiasis (2%), obstructive megaureter in duplex systems (1%), ureterocele in duplex systems (1%), ureteral stenosis (1%), and ureterocele with obstructive bladder lithiasis (1%). Conclusion: Predominantly malformative in origin, obstructive uropathies necessitate ultrasound of the urinary tract as a primary diagnostic tool. Their etiologies are posterior urethral valves, pyeloureteric junction obstruction, and obstructive urolithiasis.