Vesicoureteral Reflux and Ureteropelvic Junction Obstruction: Association, Treatment Options and Outcome

Abstract

High grade vesicoureteral reflux is associated with ureteropelvic junction obstruction. No association with low or intermediate grade reflux was demonstrated. While some patients may be monitored expectantly, in our series pyeloplasty or nephrectomy was required in 81% and ureteroneocystostomy was required in 36%. In no case did primary ureteroneocystostomy protect against the subsequent need for pyeloplasty.

The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis

“…When either diagnosis is a consideration, a VCUG to rule out VUR as the cause of dilatation should be performed. It should be kept in mind that VUR may coexist with UPJ obstruction in as many as 10% of children [117]. Currently, there is no clear evidence to support or to avoid postnatal imaging for VUR.…”

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

“…Continued follow-up is vital. 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].…”

“…The management of patients with dual pathology depends on whether true obstruction is present or not [28,29]. Currently, the most accurate method of determining UPJO is diuretic renography (RFS) [27,30].…”

Ureteropelvic junction obstruction presenting after antireflux surgery

“…High-grade VUR can increase the risk of UPJO up to 5-folds,[3] probably because of tortousity, kinking, and periureteritis at the UPJ. [4] This entity is suspected when the degree of dilatation in renal pelvis is disproportionate to that of the ureter, the contrast does not fill the renal pelvis thoroughly or if does so, the pelvis does not empty after voiding during a VCUG.…”