Pathophysiology and treatment of ureteropelvic junction obstruction

Abstract

This paper reviews the current literature on both the pathophysiology and treatment options for ureteropelvic junction obstruction (UPJO). A medical literature search using Pubmed/Medline that addressed both the pathophysiology of UPJO and the different treatment options for the adult and pediatric population with UPJO was performed. The pathophysiology of UPJO is still unknown but appears to be multifactorial. Perhaps future molecular studies will give us an answer to the etiology and also a pathway in preventing UPJO. Treatment options have been studied in-depth, and the gold standard is open pyeloplasty. In both the pediatric and adult population, laparoscopic or robotic pyeloplasty has similar success rates to open pyeloplasty with the benefits of minimally invasive surgery. In the pediatric population, however, further studies need to be done. Endopyelotomy also has a role in the treatment of UPJO but should have strict selection criteria.

Outcome analysis of robotic pyeloplasty: a large single‐centre experience

“…Since the beginning of minimally invasive era, different approaches have been used to treat the disease, in an effort to reduce the morbidity associated with the open procedure. Endoscopic approaches, whether antegrade or retrograde, excelled in terms of reducing invasiveness but have yielded poor long-term success rates [1][2][3]13,14]. The laparoscopic approach has since been developed, with the advantages of reduced pain, hospital stay, morbidity and outcomes superior to endoscopic approaches.…”

“…Minimally invasive options like balloon dilatation, antegrade or retrograde endopyelotomy (laser, cold-knife or electrocautery) and endopyeloplasty have not provided sufficient and durable clinical efficacy for routine recommendation [1][2][3][4]. In 1993, Schuessler et al [5] started using laparoscopic pyeloplasty (LP), which had emerged as an alternative to open pyeloplasty and with comparable results [6,7].…”

Neonatal Imaging Evaluation of Common Prenatally Diagnosed Genitourinary Abnormalities

“…The etiology of UPJ obstruction currently remains uncertain; however, the condition is most likely multifactorial and related to abnormalities of smooth muscle cell development, involving largely unknown molecular pathways. 60,62 The causes of UPJ obstruction are generally classified as intrinsic or extrinsic. Intrinsic obstruction usually occurs at the point at which the ureter joins the pelvis; and it is believed to be the result of an abnormal deposition of muscle and collagen resulting in an aperistaltic segment that fails to transport urine.…”

До Питання Відведення Сечі При Вродженому Гідронефрозі В Дітей

“…сти на питання про причину гідронефрозу та шляхи запобігання йому [16]. Серед причин гідронефро-зу найчастішою вважається внутрішня обструкція.…”

“…Успішні результати застосування вка-заної методики досягають, за даними різних авторів, 95 %. У той же час за наявності зовнішньої обструкції (додаткові судини) ендоскопічні (ендоуретральні) методики не показані взагалі, лише пластика ПУС за Хайнсом -Андерсеном (реанастомозування) спе-реду від судинного пучка [9,12,13,16]. Ряд авторів указують на відсутність необхідності в стентуванні чи нефростомії при пієлопластиці в дітей [2].…”