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URETEROPELVIC JUNCTION OBSTRUCTION

What is ureteropelvic junction obstruction?
It is a blockage of the ureter at the level of the renal pelvis-proximal ureteral junction.
 
What are the causes?
The causes can be divided into congenital or acquired. Congenital ureteropelvic junction obstruction is an entity that is often now found prenatally. Inasmuch as prenatal ultrasonography is routinel) performed. it will present as one of the differential diagnoses of prenatal or postnatal hydronephrosis or abdominal mass. Acquired ureteropelvic obstruction may be the result of ureteral manipulation, urinary calculi, or retroperitoneal disease.
 

What are the physical findings and symptoms?

One might be able to appreciate an abdominal mass. In the older child, there might be flank or abdominal pain.
 
How is the diagnosis of ureteropelvic junction obstruction made?
Renal ultrasonography, intravenous pyelography, or radionuclide renogram.
 
What are the causes of congenital anomaly?
IIt is believed that there is a disorganization of the renal pelvis-upper ureteral junction during the recanalization process in utero. This disorganization of the smooth muscle leads to a lack of motility or perhaps collagen deposition, and thus there is a lack of peristalsis, with narrowing at this site.

 
How does one treat this entity?
A pyeloplasty is usually performed in the neonate. There are several types of pyeloplasy procedures, the most common being the dismembered pyeloplasy.
 

Are there any other causes for pediatric ureteropelvic junction obstruction?
It may be that vesicoureteral reflux may cause a secondary ureteropelvic junction obstruction. This is most commonly found in children.
 
does one make a diagnosis of ureteropelvic junction obstruction in children?
Diuretic renal nuclide scanning is usually performed either to make the diagnosis of uretempelvic junction obstruction or to confirm the diagnosis.
 

Is ureteropelvic junction obstruction more common in male or female children?
Boys more than girls by a 5:2 ratio.
 
 

Is ureteropelvic junction obstruction more common on the right, left, or both (bilateral)?
It is more common on the left than the right, again with a 5:2 ratio. Bilateral obstruction occurs in 15% of cases.
 
 
What are the causes of this obstruction in the adult?
I. A crossing renal vessel at the ureteropelvic junction
2. PrevIOus passage of a urinary calculus
3. Manipulation of the urinarY system either with a ureteroscope or nephroscope.
4. A retroperineal process impinging on the ureter externally (e.g., inflammation or enlarged lymph nodes)
5. Nonurologic malignancies such as gynecologic cancers or colonic cancers can causing obstruction either through enlarged lymph nodes or actual compression of that area by the tumor burden
6. Abdominal and aortic aneurysm leakage may produce an inflammatory response in the retroperineal area near the upper ureteropelvic junction, causing uretopelvic junction obstruction as well
7. Infection, either hematogenous or ascending
 
How is the obstruction treated in the adult?
Most commonly, a dismembered pyeloplasty is performed in the adult. Other types of pyeloplasties also may be performed. Minimally invasive techniques such as endopyelotomy, a procedure performed via a percutaneous opening through the skin to the kidney, allowing access to the ureteropelvic junction area from below, or through the ureter in a retrograde fashion (a retrograde ureteral endopyelotomy) can be performed as well

 
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