Management of ureteropelvic junction obstruction in adults

Abstract

Ureteropelvic junction obstruction (UPJO) is characterized by impaired flow of urine from the renal pelvis to the ureter. Untreated disease can result in renal impairment making effective management crucial. A combination of CT imaging and diuretic renography is typically used for diagnosis. CT is the investigation of choice for obtaining anatomical information about UPJO and can help to identify potential causes. Diuretic renography is best for providing functional information about UPJO. A variety of open and minimally invasive surgical techniques are available for treatment of UPJO. Traditionally open pyeloplasty has been the standard of care but minimally invasive surgical techniques have become increasingly popular. Endopyelotomy has a lower success rate than other modalities (42-90% depending on the approach), but is associated with reduced pain and shorter convalescence. Laparoscopic pyeloplasty and robot-assisted pyeloplasty have similar success rates to open pyeloplasty (>90%), with the additional advantages of significantly reduced morbidity and shorter convalescence. More long-term outcome data for minimally invasive surgical techniques are awaited.

Peri‐operative outcomes and complications after laparoscopic vs robot‐assisted dismembered pyeloplasty: a systematic review and meta‐analysis

“…Table shows the characteristics of included studies. All 17 were observational studies . Thirteen studies had a retrospective design [], three were prospective , and one used both retrospective and prospective data collection .…”

“…Table 1 shows the characteristics of included studies. All 17 were observational studies [2,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Thirteen studies had a retrospective design [3,[11][12][13][14][15][16][17][18][22][23][24][25], three were prospective [10,19,20], and one used both retrospective and prospective data collection [21].…”

Variation in the Use of Open Pyeloplasty, Minimally Invasive Pyeloplasty, and Endopyelotomy for the Treatment of Ureteropelvic Junction Obstruction in Adults

“…More robust outcomes data are needed to assess the comparative effectiveness of these three treatments. Insofar as the morbidity of the minimally invasive approach is low and the success rate is superior to that of endopyelotomy as some prior studies indicate, 21,23 more research needs to examine the contexts for primary treatment with endopyelotomy. Perhaps many of these procedures are performed in a salvage setting or more for a ureteral stricture than a true ureteropelvic junction obstruction.…”

Comparación de los resultados a mediano plazo entre la pieloplastia abierta versus laparoscópica en pacientes adultos con obstrucción de la unión ureteropiélica

“…[5][6][7] El procedimiento quirúrgico se indica en pacientes con síntomas asociados con la obstrucción, diferencia funcional en la tasa de filtrado glomerular en ambos riñones, nefrolitiasis e hipertensión arterial sistémica. 1 Existen pocos estudios en México que comparan los resultados de la pieloplastia abierta versus laparoscópica en la reparación de la obstrucción de la unión ureteropiélica en adultos, por lo que hacer una comparación con lo descrito en otros países es difícil. De acuerdo con estos datos, el objetivo de este estudio fue describir y comparar las características preoperatorias, las complicaciones perioperatorias y los resultados a mediano plazo de pacientes con pieloplastia abierta y laparoscópica por obstrucción de la unión ureteropiélica primaria o secundaria.…”