Causes of upper urinary tract obstruction
- PUJ obstruction - idiopathic, retroperitoneal fibrosis, secondary to trauma or infection
- Extrinsic ureteric compression - e.g. retrocaval ureter, AAA
- Intraluminal pathology - tumour or stone
- Intramural pathology - primary megaureter
Idiopathic PUJ obstruction
- PUJ obstruction is more common in men
- Affects left kidney more often than right
- 10% cases are bilateral
- Aetiology is unknown but important factors may be
- Aberrant lower pole vessels
- Persistent foetal urothelial fold
Clinical features
- Usually presents in adolescence or early adult life
- Presenting symptom may be loin pain - worse after alcohol
- In late cases a renal mass may be palpable
- Haematuria is an uncommon feature
- 10% develop UTIs and 3% renal colic
Investigation
- Diagnosis can be confirmed by ultrasound
- IVU or retrograde ureterogram show a classical appearance
- Isotope renography allows assessment of percentage of renal function
Management
- The aims of treatment are to:
- Relieve symptoms
- Preserve renal function
- Can achieved by a pyeloplasty
- In the United Kingdom the Anderson-Hymes Pyeloplasty is the commonest procedure
- If severe renal impairment (<20% function)
- Nephrectomy may be required
Bibliography
Borralashi M D, Hirschi R B, Bloom D A. Vesicoureteral reflux and ureteropelvic junction obstruction:
association, treatment options and outcome. J Urol 1997; 157: 969-974.
Streem S B. Ureteropelvic junction obstruction. Open operative intervention. Urol Clin North Am 1998;
25:331-341. |