Endoureterotomy as the Initial Management of Concurrent Ureteropelvic and Ureterovesical Junction Obstruction After Failed Conservative Therapy

Ebadi, Maryam; Kajbafzadeh, Abdol‐Mohammad; Mousavian, Amir-Abbas

doi:10.1016/j.urology.2013.02.048

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…UVJO causes increment in smooth muscle contractility as well as in cholinergic and adrenergic activity in distal ureter of rabbits (3). UVJO may coexist with UPJO and this may cause a problem both in diagnosis and in management (4)(5)(6). In this situation, all diagnostic imaging techniques should be employed for defining the correct diagnosis and proper management of both conditions.…”

Section: Discussionmentioning

confidence: 99%

The Dilemma of Ureterovesical Junction Obstruction

Rabani

Mousavizadeh

2017

Nephro-Urol Mon

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Background: Ureterovesical junction obstruction (UVJO) is the result of an anatomic or a functional abnormality in the distal segment of the ureter. There are many types of UVJO, different in their cause, presentation, imaging characters, and prognosis. Objectives: The aim of this study was to discuss the postoperative natural course and prognosis of patients undergoing standard approaches on the management of primary UVJO by one surgeon in a 10-year period starting from 2004. Methods: From January 2004 to October 2013, 64 patients who underwent ureteral tapering and stenting ureteroneocystostomy for complicated primary UVJO participated in the study. Results: The mean age of patients was 26 years (range: 11 months to 73 years). The mean hospital stay was 5 days (range: 4 to 7 days). The post-operative time was between 1 and 2 hours. Double J stent was left in place for 4 weeks. Post-operative follow-up was at least one year. No major complication was encountered, instead, a decrease in symptoms in all patients and an increase in renal function in 40 out of 64 (62.5%) patients were observed in the one-year follow-up of the diethylenetriaminepentaacetic acid (DTPA) renal scanning. Only 3 patients had fever as a postoperative minor complication. Conclusions: Decision making in the treatment of UVJO is somewhat a dilemma. This condition is occasionally asymptomatic and uneventful, and may be detected accidentally during an unrelated work-up; nonetheless, it may also cause serious life threatening complications. Surgical management in complicated cases may be a safe and viable treatment option both in children and in adults.

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Section: Discussionmentioning

confidence: 99%

The Dilemma of Ureterovesical Junction Obstruction

Rabani

Mousavizadeh

2017

Nephro-Urol Mon

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“…Reviewing the literature, we found 110 patients with the association of PUJO and POM reported in 10 articles (Table 1) [3,[13][14][15][16][17][18][19][20][21][22]. The available literature showed that the diagnosis of double obstruction was carried out in 67.3% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Reviewing the literature, we found 110 patients with the association of PUJO and POM reported in 10 articles (Table 1) [3,[13][14][15][16][17][18][19][20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…It is not known whether the two obstructions developed together or if one was the cause for the other [18,21]. Ebadi et al hypothesized that the ureteral kinking caused by the obstruction at the UVJ level produced a secondary PUJO; therefore, by first approaching UVJO, there is a chance for spontaneous resolution of the concomitant PUJO because it eliminates the primary cause [18].…”

Section: Discussionmentioning

confidence: 99%

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Combined Minimally Invasive Treatment of Pyeloureteral Junction Obstruction and Primary Obstructive Megaureter in Children: Case Report and Literature Review

Di Fabrizio,

Tavolario,

Rossi

et al. 2024

Children

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Introduction: In children, the association of ipsilateral pyeloureteral junction obstruction (PUJO) and ureterovesical junction obstruction (UVJO) is a rare malformation with a non-standardized treatment. We report a case of PUJO and UVJO treated by a combined minimally invasive surgical treatment to resolve the double urinary obstruction. The current literature was also reviewed. Case report and review: A two-month-old boy, without antenatal and postnatal signs of urinary tract anomalies, was hospitalized presenting right hydronephrosis, perirenal fluid effusion, and ascites. An acute pelvic rupture was suspected, and a retrograde pyelogram was performed, showing a primary obstructive megaureter (POM) associated with a corkscrew pyeloureteral junction. The impossibility to place a double J catheter through the pyeloureteral junction led us to achieve percutaneous nephrostomy and an abdominal drain placement. Three months later, the patient underwent a combined high-pressure balloon ureterovesical junction dilation and retroperitoneoscopic Anderson Hynes one-trocar-assisted pyeloplasty (OTAP). The literature search identified 110 children experiencing double urinary tract obstruction. All authors agreed on the difficulty to diagnose both obstructions preoperatively, but there is still no consensus on which obstruction should be relieved earlier, because the alteration in urinary vascularity during a double surgery could damage the ureter. Conclusions: The simultaneous occurrence of UPJO and UVJO is rare, with a challenging diagnosis. Prompt identification and timely surgical intervention are crucial to mitigate the risk of renal function loss attributable to obstruction and infection. Drawing from our expertise and the analysis of the existing literature, we propose employing a simultaneous double minimally invasive strategy in order to optimize the preservation of ureteral vascularity. This approach entails performing a minimally invasive pyeloplasty for the PUJ and utilizing high-pressure balloon dilatation for the UVJ.

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“…On the other hand, ureteropelvic junction obstruction (UPJO) is recognized as the most common defect of the upper urinary tract in children, also, it is the second most common abnormality in the context of MCRD after contralateral vesicoureteral reflux 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

Early pyeloplasty and excision of a multicystic kidney in a neonate with a complicated nephrostomy: A case report

Raslan

Danial²,

Khallouf

et al. 2023

Annals of Medicine &Amp; Surgery

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Introduction and Importance: The association of multicystic renal dysplasia with ureteropelvic junction obstruction is noteworthy in newborn. However, the possibility of conservative management is still a primary requirement, unless there are complications that suggest surgery. The authors are studying a case of a newborn in which an incorrect nephrostomy led to complications that required emergency surgery. Case Presentation: A newborn girl with left-side ureteropelvic junction obstruction and an enlarged and multicystic right kidney was operated on at an early age by unexpert hands, leading to complications. Was monitored daily, and an emergency procedure was done. Following up shows the success of the emergency operation. Clinical Discussion: The age and the precise timing of intervention are controversial. In this case, several postnatal diagnostic tests were made due to the severity of the hydronephrosis in the antenatal period, which resulted in the implementation of percutaneous nephrostomy. Conclusion: Authors suggest that it is better to not operate as long as the patient’s condition is stable

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Endoureterotomy as the Initial Management of Concurrent Ureteropelvic and Ureterovesical Junction Obstruction After Failed Conservative Therapy

Cited by 7 publications

References 19 publications

The Dilemma of Ureterovesical Junction Obstruction

The Dilemma of Ureterovesical Junction Obstruction

Combined Minimally Invasive Treatment of Pyeloureteral Junction Obstruction and Primary Obstructive Megaureter in Children: Case Report and Literature Review

Early pyeloplasty and excision of a multicystic kidney in a neonate with a complicated nephrostomy: A case report

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