1. Ureteropelvic Junction Obstruction
Jabbari A, MD
Urology Department
Tabriz University of Medical Sciences

2. درمان UPJO اهداف درس: آشنایی با هیدرونفروز پری ناتال و UPJO
روش ارزیابی :
تئوری بیشتر بصورت MCQ
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3. The diagnosis of “ureteropelvic junction obstruction” results in a functionally significant impairment of urinary transport from the renal pelvis to the ureter.
Most cases are congenital, the problem may not become clinically apparent until much later in life.
Acquired conditions:
Stone disease
Postoperative or inflammatory stricture
Urothelial neoplasm

4. Most abdominal masses originate in genitourinary organs in the neonatal period.

5. The basic features of UPJO in the fetus include dilation of the renal pelvis and collecting system with no evidence of ureteral dilation.
UPJO is the most common cause of significant dilation of the collecting system in the fetal kidney.
Obstruction occurs more commonly in boys than in girls

6. In neonates and infants, the diagnosis of UPJO has generally been suggested either by routine maternal ultrasonography or by the finding of a flank mass.
In either setting, renal ultrasonography is usually the first radiographic study performed.

10. Diuretic renography remains a commonly used study for diagnosing UPJO because it provides quantitative data regarding differential renal function and obstruction, even in hydronephrotic renal units.
DTPA
MAG3 (the preferred isotope)

12. Etiology
The precise cause of UPJO remains elusive: embryologic, anatomic, functional, and histologic.
A narrowing of the UPJ is a result of developmental arrest or of an incomplete recanalization of the ureter ??
Intrinsic : (Presence of an aperistaltic segment of the ureter)
Extrinsic

14. Secondary UPJO
UPJ obstruction may also be seen with severe vesicoureteral reflux (VUR).
The ureter elongates and develops a torturous course in response to the reflux. kink may develop in the UPJ area, and may cause an obstruction secondarily

15. Associated Anomalies
Congenital renal malformations are commonly seen in association with UPJ obstruction.
UPJO is the most common anomaly encountered in the opposite kidney; 10% to 40% of cases.
Renal dysplasia
Multicystic kidney
Unilateral renal agenesis in 5% of children

16. Indications for Intervention
Indications for intervention for UPJO include:
Presence of symptoms
Impairment of renal function or ipsilateral function
Development of stones or infection
Hypertension
The primary goal of intervention is relief of symptoms and preservation or improvement of renal function.

17. Options for Intervention
Endourologic
Laparoscopic and Robotic
Open Operation

18. Endourologic Management
Endopyelotomy
Antegrade
Retrograde
Indications (same)
Contraindications include a long segment (>2 cm), active infection, or untreated coagulopathy.
The advantages of endourologic approaches include reduced hospital stays and postoperative recovery.
The success rate ( %) does not approach that of open, laparoscopic, or robotic pyeloplasty.

20. Laparoscopic Pyeloplasty
In the hands of the experienced laparoscopic surgeons, has lower patient morbidity, shorter hospitalization, and faster convalescence.
The success rates matching those of open pyeloplasty (≥90%).
Absolute contraindications include:
Uncorrected coagulopathy
Active urinary tract infection
Cardiopulmonary problems

21. Open Operative Intervention
The success rate is %.
Dismembered Pyeloplasty
Foley Y-V-Plasty
Culp-DeWeerd Spiral Flap
Scardino-Prince Vertical Flap

22. Dismembered Pyeloplasty

24. Foley Y-V-Plasty

25. Culp-DeWeerd Spiral Flap

26. Scardino-Prince Vertical Flap