What we know and what we dont know article pdf available in korean journal of urology 505 may 2009 with 305 reads. This obstruction can lead to an increase in backpressure on the kidney, hydronephrosis, and progressive damage to the kidney function. This blockage typically occurs at the renal pelvis, which is where the kidney attaches to one of the ureters tube that carries urine from the kidney to the bladder. Although josef dietl1 first described this clinical entity in 1864, and numerous reports appear in the english language urologic and radiologic. Currently, less invasive techniques are used for the treatment of ureteropelvic junction obstruction. Ureteropelvic yuhreetuhroepelvik junction obstruction is a partial or total blockage of the flow of urine pee in the area where a ureter attaches to a kidney. We report the case of a 15yearold boy, who is known to. The reference standard for treatment of ureteropelvic junction obstruction upjo has been open pyeloplasty, with a success rate of over 90%. The etiology of upj obstruction includes both congenital and acquired conditions.
Profile and outcome of pelviureteric junction obstruction. It occurs in an estimated 1 in 1500 live births and is the most common cause of prenatal hydronephrosis fig. Conversely, a dilated distal ureter can be observed with ureterovesical junction obstruction, megaureter, vesicoureteral reflux, or ureteral ectopia. Pelviureteric junction puj obstruction is a partial or total blockage of the flow of urine that occurs where the ureter enters the kidney and is the. The three goals of imaging for ureteropelvic junction upj obstruction are to determine the presence and degree of renal obstruction, to assess renal function, and to determine the cause of the pr. Ureteropelvic junction definition of ureteropelvic. When this area forms abnormally during fetal development, it can cause a blockagea congenital condition known as ureteropelvic junction obstruction upj obstruction. Clinical significance of minimal sentinel node involvement and management options the clinical significance of doppler umbilical artery velocimetry in the small for gestational age fetus.
Ureteropelvic junction obstruction upjo is the most common cause of postnatal hydronephrosis. Upj obstruction is more common in males and is most often leftsided. Pediatric congenital hydronephrosis ureteropelvic junction. Ureteropelvic junction upj obstruction riley childrens. The area where the kidneys and ureters meet is called the ureteropelvic junction upj.
Aug 15, 2018 ureteropelvic junction upj obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 2000 newborns. When occurring in childhood, it is frequently bilateral 16%, associated with other urologic malformations 15% to 20%, predominantly on the left side, and predominantly in boys. Ureteropelvic junction obstruction upjo in infants. Ureteropelvic junction upj obstruction cedarssinai. Ureteropelvic junction upj obstruction is the most common obstructive uropathy in children. The term ureteropelvic junction upj obstruction describes a. Laparoscopic pyeloplasty for ureteropelvic junctions. Ureteropelvic junction upj obstruction is when part of the kidney is blocked. Download fulltext pdf ureteropelvic junction obstruction.
Pdf robot assisted laparoscopic pyeloplasty in patients. Ureteropelvic junction article about ureteropelvic junction. Since ureteropelvic junction obstruction is the most common upper urinary tract problem in children, and vesicoureteral reflux the most common lower tract problem, it is not surprising that these entities sometimes coexist in the same child. Jacobs bl, lai jc, seelam r, hanley jm, wolf js jr, hollenbeck bk, hollingsworth jm, dick aw, setodji cm, saigal cs. Ureteropelvic junction upj obstruction is the most common cause of upper urinary tract obst ruction in neonates and infants, with a frequency of 1 in 2,000, a nd it is commonly suspected based on prenatal imaging 1,2. Ureteropelvic junction obstruction is the most common cause of ureteral obstruction and may present at any age. Left hydronephrosis with severe pelvic dilatation and normal caliber ureter suggesting stenosis of the ureteropelvic junction. Ucsf department of urology ureteropelvic junction obstruction.
Ureteropelvic junction obstruction refers to a blockage where the renal pelvis meets the ureter. Ureteropelvic junction obstruction is a condition where blockage occurs at the junction where the ureter attaches to the kidney. Pelviureteric junction puj obstruction, ureteropelvic junction upj obstruction what is puj obstruction. The diagnosis of ureteropelvic junction obstruction upjo implies functionally significant impairment of urinary transport from the renal pelvis to the ureter. Background a 56yearold male with bilateral flank pain was admitted following diagnosis of bilateral kidney stone disease. Ureteropelvic junction obstruction brigham and womens hospital. Puj obstruction and laparoscopic pyeloplasty patient information marc e laniado md frcsurol febu consultant urological surgeon page 1, revision date. The term ureteropelvic junction upj obstruction describes a blockage to this area. The treatment of ureteropelvic junction has evolved considerably over the past 20 years, resulting in new surgical techniques, but traditional open surgery remains the gold standard treatment. These obstructions develop prenatally as the kidney is forming and today most are diagnosed on prenatal ultrasound screening. Ultrasonography will reveal a dilated renal pelvis with or without caliectasis, and the absence of ureteral dilatation figure 842. The blockage slows or stops the flow of urine out of the kidney.
The aim of this study is to assess the outcome of laparoscopic pyeloplasty in patients with upjo. Pdf management of ureteropelvic junction obstruction in adults. What causes ureteropelvic junction upj obstruction. Ureteropelvic junction upj obstruction is a blockage or narrowing between the kidney pelvis and the ureter. Among the anatomic causes, ureteropelvic junction obstruction upjo is the most common lesion, paralleling that seen in adults 1.
Pathophysiology and treatment of ureteropelvic junction. Robotassisted laparoscopic pyeloplasty for ureteropelvic. Intermittent ureteropelvic junction obstruction, often associated with an aberrant vessel to the lower pole of the kidney, may cause a distinct clinical syndrome of episodic crampy upper abdominal pain, nausea, and vomiting known as a dietl crisis. Unilateral hydronephrosis without hydroureter may indicate a ureteropelvic junction upj obstruction. Ureteropelvic junction obstruction upjo, or pelviureteric junction obstruction, is defined as a blockage or obstruction of urine flow from the kidney into the proximal upper ureter. Noel, in nelson pediatric symptombased diagnosis, 2018. The remaining three papers address the surgical management of the obstructed infant upj. Ureteropelvic junction upj obstruction is being detected with increasing frequency before birth. Ureteropelvic junction obstruction beer drinkers kidney, dietl crisis is caused by partial obstruction at the ureteropelvic junction and by.
This problem occurs in approximately one in 1,500 children. Surgical indications for unilateral neonatal hydronephrosis in. Ureteropelvic junction upj obstruction is by far the most common cause of pediatric hydronephrosis. Bilateral kidney stones with ureteropelvic junction obstruction. Ureteropelvic medical definition merriamwebster medical. Following diagnosis and successful treatment of the uti, the doctor may order tests to detect abnormalities such as vesicoureteral reflux backflow of urine from bladder to ureter andor kidneys, ureteropelvic junction blockage thinning or blockage of the junction of ureter and kidney, ureterovesicular junction blockage blockage of the junction of ureter and bladder, and urethral blockage. This causes a decreased flow of urine through the ureter and an increase in fluid pressure inside the kidney.
Ureteropelvic junction an overview sciencedirect topics. It is the most common congenital cause of obstruction blockage in the urinary tract. Jan 14, 2019 ureteropelvic junction upj obstruction is a partial or intermittent total blockage of the flow of urine that occurs where the ureter enters the kidney. Ureteropelvic junction obstruction ureteropelvic junction obstruction is commonly referred to as a upj obstruction. Medical reports of 47 upjo patients treated with laparoscopic pyeloplasty were retrospectively analysed.
On the basis of a series of cases that were referred to the authors in their clinical practice, they found that the unprecedented quality and novel perspectives of multidetector row computed tomography ct with two and threedimensional postprocessing. Congenital ureteropelvic junction upj obstruction is a well recognized pathology. Through more than 40 years of development in the field of upj obstruction in infants, there have been several advances in management but controversies. Pdf laparoscopic treatment for ureteropelvic junction. Surgical management of ureteropelvic junction obstruction in adults article pdf available in international braz j urol 291. On the basis of a series of cases that were referred to the authors in their clinical practice, they found that the unprecedented quality and novel perspectives of multidetector row computed tomography ct. Ureteropelvic junction upj obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder ureters. Apr 07, 2010 ureteropelvic junction upj obstruction is the most frequently observed cause of obstructive nephropathy in children. Hydronephrosis in the course of ureteropelvic junction obstruction. Ureteropelvic junction upj obstruction is the most frequently observed cause of obstructive nephropathy in children.
It can be congenital or acquired with a congenital puj obstruction being one of the commonest causes of antenatal hydronephrosis. He had previously undergone four separate pyelolithotomy sessions two. Case discussion ct shows left hydronephrosis with severe pelvic dilatation and normal ureter suggesting ureteropelvic junction upj obstruction. Prior to fetal ultrasonography, ureteropelvic junction obstruction upjo was most often identified in a child after evaluation revealed an abdominal mass, intermittent abdominal or flank pain and vomiting, or a urinary tract infection. Ureteropelvic junction obstruction by aberrant lower pole artery. This study aimed to evaluate laparoscopic dismembered pyeloplasty compared with open surgery and to determine whether the morbidity and outcome rates are different in each of these techniques. Ureteropelvic junction obstruction in the fetus sciencedirect. Upj obstruction may be diagnosed before birth but it is also found in adults.
In some cases an inherited tendency to obstructions will run in a family, but usually an obstruction appears in just a single family member. Ureteropelvic junction obstruction european urology supplements. Ureteropelvic junction upj obstruction cleveland clinic. Stentless pyeloplasty for ureteropelvic junction obstruction in children. Single session endoscopic management of intrinsic ureteropelvic. Ppt ureteropelvic junction obstruction powerpoint presentation free to download id. Oct 07, 2014 pdf ureteropelvic junction obstruction upjo is characterized by impaired flow of urine from the renal pelvis to the ureter. This is where the kidney attaches to one of the ureters the tubes that carry urine to the bladder. Management of ureteropelvic junction obstruction in adults. Ureteropelvic junction obstruction ucsf department of. On the basis of a series of cases that were referred to th.
Pdf management of ureteropelvic junction obstruction in. Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of hydronephrosis. In a child with ureteropelvic junction upjo obstruction, part of a kidney is blocked. A medical literature search using pubmedmedline that addressed both the pathophysiology of upjo and the different treatment options for the adult and pediatric population with upjo was performed. Pdf ureteropelvic junction obstruction upjo is characterized by impaired flow of urine from the renal pelvis to the ureter. A ureteropelvic junction obstruction upjo is a blockage of urine flow from the renal pelvis to the ureter. About one child in every births is diagnosed with a upjo. Ureteropelvic junction obstruction upjo is a common cause of symptomatic ureteral obstruction. This obstruction can lead to an increase in backpressure on the kidney, hydronephrosis, and progressive damage to. Ureteropelvic junction obstruction european urology. The ureteropelvic junction is located where the pelvis of the kidney meets the ureter the tube that drains urine into the bladder. Evolution in the treatment of the ureteropelvic junction.
A and b, longitudinal and transverse images of the right kidney in a. The blockage can be partial or complete with varying degrees of severity. Failure of the ureteropelvic junction to become patent during development is the most frequent cause of bilateral hydronephrosis, particularly in male neonates. Congenital ureteropelvic junction obstruction upjo is the most common cause of upper urinary tract obstruction in children.
May 23, 2015 ureteropelvic junction upj obstruction is defined as a partial or complete obstruction of the flow of urine from the renal pelvis to the proximal ureter. Neonatal and foetal animal models have been developed that mimic closely what is observed in human disease. Ureteropelvic junction upj obstruction occurs when the area connecting the renal pelvis part of the kidney to one of two tubes that connect with the bladder ureter becomes blocked, causing urine to build up, which damages the kidneys. Krajewski w, wojciechowska j, dembowski j, zdrojowy r, szydelko t. A mag3 mercaptoacetyltriglycine renal scan with furosemide. To clarify the natural history of fetal upj obstruction, we. The ureteropelvic junction upj is the junction between the proximal ureter and renal pelvis. Early diagnosis allows salvage of renal tissue as well as renal function. What we know and what we dont know hyeyoung lee, sang won han from the deparment of urology, urological science institute, yonsei university college of medicine, seoul, korea purpose. Ureteropelvic junction obstruction upjo is rarely associated with a duplex collecting system. Ureteropelvic junction obstruction and parathyroid adenoma. However, hydronephrosis now is usually diagnosed antenatally and affects approximately 1 in 1500 live births. Ureteropelvic junction upj obstruction is a partial or intermittent total blockage of the flow of urine that occurs where the ureter enters the kidney.
Hydronephrosis hydronephrosis is a dilation of the kidney collecting system plumbing. What is a pediatric ureteropelvic junction obstruction upjo. This results in decreased flow of urine down the ureter and an increase of fluid pressure inside the kidney. Pdf comparison of open and laparoscopic pyeloplasty in. Variation in the use of open pyeloplasty, minimally invasive pyeloplasty, and endopyelotomy for the treatment of ureteropelvic junction obstruction in adults. Ureteropelvic junction obstruction european urology open science. Figure 1 what are the symptoms of a ureteropelvic junction obstruction. Congenital ureteropelvic junction obstruction uptodate. The renal pelvis is located at the upper end of each ureter tube that drains urine from the kidneys to the bladder. The coexistence of ureteropelvic junction obstruction and. Current opinions on the pathogenesis, diagnosis and treatment. Ureteropelvic junction obstruction upjo is a benign, congenital condition that remains an enigma in terms of both diagnosis and therapy. Surgical management of ureteropelvic junction obstruction.
Ureteropelvic junction definition of ureteropelvic junction. Ureteropelvic junction obstruction upjo, or pelviureteric junction obstruction, is defined as a blockage or obstruction of urine flow from the kidney into the. A upj obstruction can also occur if a blood vessel is positioned incorrectly over the ureter. The prevalence of asymptomatic hydronephrosis, now detected by ultrasonography, has increased. Overall, the findings appeared to be consistent with a ureteropelvic junction upj obstruction.
Ureteropelvic junction upj obstruction is an established cause of renal damage in the pediatric population. Nine patients who were treated conservatively, one who underwent nephrectomy, and one pyelostomy for. In one year, robotassisted laparoscopic pyeloplasty was performed in nine patients for. However, definitive management guidelines for the management of congenital hydronephrosis have not been. Most upj obstructions are present at birth, an indication that structures of the ureter or kidney did not form correctly as the fetus was developing. Imaging for ureteropelvic junction obstruction in adults. Pelviureteric junction obstruction puj is one of the most common congenital abnormalities of the urinary tract. Although most cases are probably congenital in origin, the problem may not become clinically apparent until much later in life. Ureteropelvic junction upj obstruction may be defined as a functional or anatomic obstruction to urine flow from the renal pelvis to the proximal ureter. Open surgery, however, is associated with significant morbidity, including the need of a large incision, longer convalescence, and increased postoperative pain.
Ureteropelvic junction obstruction upjo is a common anomaly of the genitourinary tract, and laparoscopic pyeloplasty is a standard approach for patients because its longterm outcome is equivalent to open approach. Obstruction bilateral hydronephrosis with hydroureter may point to posterior urethral valves, an anterior urethral valve, prune. Hydronephrosis can be found on ultrasounds and other xrays. It typically occurs due to the presence of an aperistaltic segment of the ureter, very frequently aggravated by. Ureteropelvic junction upj obstruction is a blockage at the junction where the ureter attaches to the kidney. Pyeloplasty, which involves excision of the stenotic section and creation of a new junction, is the most common and effective treatment for this problem. Pdf ureteropelvic junction obstruction by aberrant lower. Ureteropelvic junction upj obstruction is a blockage in the renal pelvis of the kidney.
Ureteropelvic junction obstruction and hydronephrosis. This obstruction occurs where the ureter the tube that drains the kidney inserts into the kidney. The three goals of imaging for ureteropelvic junction upj obstruction are to determine the presence. The renal pelvis is the part of the kidney that collects the urine made by the kidney and the ureter is the tube that carries the urine from the renal pelvis to the bladder see figure 1. When urine backs up in the kidney, the kidneys are no longer able to filter blood, remove waste products and make urine. Congenital malformations with obstruction of the ureteropelvic junction are a common cause for hydronephrosis fig. It is generally diagnosed in the routine workup during antenatal period and is characterized by spontaneous recovery. Upj obstruction causes the pee urine to back up in the kidney. Laparoscopic treatment for ureteropelvic junction obstruction.
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