Coexisting Ureteropelvic Junction Obstruction and Vesicoureteral Reflux: Diagnostic and Therapeutic Implications

Hollowell, Jean G.; Altman, Howard; Snyder, Howard M.; Duckett, John W.

doi:10.1016/s0022-5347(17)38793-1

Cited by 54 publications

(23 citation statements)

References 9 publications

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“…In our series as well as in prior reports, reimplantation may be required in a patient who previously underwent pyeloplasty [28,29]. Alternately, pyeloplasty may be required in a patient whose VUR has been treated initially [27,31].…”

Section: Vesicoureteral Refluxmentioning

confidence: 56%

“…Three clinical categories can be delineated in cases with concomitant UPJO and VUR [27]. Group 1: UPJO with incidental low grade VUR; Group 2, secondary UPJO due to high grade VUR; and Group 3, reflux associated with pseudo UPJO in which there are markedly dilated upper tracts without true obstruction.…”

Section: Vesicoureteral Refluxmentioning

confidence: 99%

“…Currently, the most accurate method of determining UPJO is diuretic renography (RFS) [27,30]. If significant obstruction is diagnosed by RFS, then pyeloplasty should be the initial approach.…”

Section: Vesicoureteral Refluxmentioning

confidence: 99%

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Prenatally detected ureteropelvic junction obstruction: clinical features and associated urologic abnormalities

et al. 2008

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Urologic congenital anomalies associated with ureteropelvic obstruction (UPJO) have been previously characterized; however, less data are available regarding these associations in a prenatally diagnosed population. A retrospective study was conducted to evaluate significant clinical features and urological anomalies associated with prenatally diagnosed UPJO. The records of 143 children with prenatally diagnosed hydronephrosis secondary to UPJO were retrospectively reviewed. The gender, side of obstruction, degree of hydronephrosis, associated clinical features, and urological anomalies were noted. Hundred and forty-three children (M/F = 2.7) with a total of 198 affected renal units (RU) presenting with unilateral (61%) or bilateral (39%) UPJO were enrolled. In cases of unilateral obstruction, the left side was affected in 60 children (68%). The grade of hydronephrosis was Grade 1 in 56 RU (28%), Grade 2 in 51 RU (26%), Grade 3 in 50 RU (25%) and Grade 4 in 41 RU (21%). Associated clinical features included prematurity (n = 7, 4.9%), twinning (n = 5, 3.5%) and presentation with renal failure (RF) (n = 2). Excluding contralateral UPJO, other urologic anomalies were encountered in 29 patients (20.3%). Associated vesicoureteral reflux (VUR) was encountered in 11 patients (7.7%, M/F = 2.7). Pyeloplasty was required more often in children with associated VUR (54.5 vs. 18.2%) (P = 0.01). Contralateral multicystic dysplastic kidney (MCDK) was encountered in six patients (M/F = 2), one of whom presented with RF. One child carried the diagnosis of Schinzel-Giedion syndrome (SGS), demonstrating severe developmental and neurological disorders and bilateral hydronephrosis. The more frequent occurrence of UPJO in males with predominantly left-sided location, association with VUR and MCDK, and increased frequency of bilaterality in our prenatally diagnosed patients were similar to historical reports. In addition, prematurity and twinning were independently associated with UPJO. The higher rate of pyeloplasty in patients with associated reflux warrants further investigation.

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Section: Vesicoureteral Refluxmentioning

confidence: 56%

Section: Vesicoureteral Refluxmentioning

confidence: 99%

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Prenatally detected ureteropelvic junction obstruction: clinical features and associated urologic abnormalities

et al. 2008

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“…[7] It is not clear that obstruction in the reported cases is because of natural history of some dilation from nonobstructive toward obstructive or as Hollowell believes, primary antireflux surgery might provoke UPJ decompensation. [8]…”

Section: Discussionmentioning

confidence: 99%

Ureteropelvic junction obstruction presenting after antireflux surgery

et al. 2012

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“…Bei diesen Kindern wurde die pränatal gestellte Diagnose einer Dilatation der oberen Harnwege postnatal sonographisch bestätigt und die Diureserenographie war Das MCU wird aufgrund der Strahlenbelastung durch die Röntgenuntersu-chung häufig kritisch diskutiert.Den Stellenwert der Untersuchungsmethode belegte Hollowell,da er bei 14% eines Kollektivs mit subpelviner Stenose einen Reflux nachweisen konnte. Dies bestätigt sich in unserer Studie im hohen Prozentsatz der parallel diagnostizierten Refluxerkrankung bei 5,8% der Kinder mit subpelviner Stenose und 50,1% der Kinder mit Megaureter [9].Wax verglich 1966 erstmalig den Wert des Diureserenogramms mit dem i.v.-Urogramm zur Beurteilung von Funktion und Abflussverhältnissen des oberen Harntraktes [21]. Der Vorteil der nuklearmedizinischen Untersuchung liegt in der geringeren Strahlenbelastung und der gleichzeitigen Beurteilungsmöglich-keit der Nierenfunktion und der Urodynamik.…”

Section: Introductionunclassified

Schwerwiegende kindliche Anomalien des Harntrakts

Eisenhardt

Arntzen

Conrad³

et al. 2003

Urologe

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As urinary tract obstruction in children may impair renal function, the early detection and evaluation of the degree of obstruction using adequate diagnostic tools is necessary for the choice of the optimal therapeutic procedure. This study describes diagnostic and therapeutic standards in relation to the quality of management of pediatric hydronephrosis in Germany in the first 6 months of the year 2000. In our study 407 of 711 (57.2%) children with a hydronephrotic condition were detected by routine ultrasound. This, and the fact that 25% of the patients, who were prenatally detected, had a diagnosis of vesicoureteral reflux, underlines the importance of this routine procedure. Our study illustrates the panel of diagnostic and therapeutic procedures used in the management of pediatric hydronephrosis in Germany.

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Coexisting Ureteropelvic Junction Obstruction and Vesicoureteral Reflux: Diagnostic and Therapeutic Implications

Cited by 54 publications

References 9 publications

Prenatally detected ureteropelvic junction obstruction: clinical features and associated urologic abnormalities

Prenatally detected ureteropelvic junction obstruction: clinical features and associated urologic abnormalities

Ureteropelvic junction obstruction presenting after antireflux surgery

Schwerwiegende kindliche Anomalien des Harntrakts

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