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  • Review Article
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Management of ureteropelvic junction obstruction in adults

Nature Reviews Urology volume 11, pages 629–638 (2014)Cite this article

Subjects

Key Points

  • Ureteropelvic junction obstruction (UPJO) is an obstructive entity resulting from multiple aetiological factors resulting in impaired flow of urine from the renal pelvis to the ureter

  • Diagnosis is based on clinical and radiological manifestations of UPJO. Contrast-enhanced CT and diuretic renography are required for confirmation of anatomical and functional obstruction, respectively

  • Surgical intervention is indicated for symptoms of obstruction and impaired split renal function. Dismembered repair is the most widely used technique and can be modified for the majority of ureteropelvic junctions

  • Endoscopic management has the advantages of shorter hospital stay and postoperative convalescence. Although initially promising, success rates do not support the use of endoscopic procedures over open, laparoscopic or robot-assisted pyeloplasty

  • Laparoscopic pyeloplasty has a low perioperative morbidity and complication rate. Although providing early durable results, intracorporeal suturing remains technically challenging and has paved the way for robot-assisted pyeloplasty

  • Robot-assisted pyeloplasty has ergonomic benefits resulting in ease of dissection and subsequent suturing with success rates of >95%. Robotic systems are reserved for tertiary centres because they have high purchase and maintenance costs

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.

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Figure 1: Anderson–Hynes dismembered pyeloplasty.
Figure 2: Foley Y-V plasty.
Figure 3: Spiral (Culp–DeWeerd) flap pyeloplasty.
Figure 4: Vertical (Scardino–Prince) flap pyeloplasty.
Figure 5: Antegrade percutaneous endopyelotomy.

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  1. Department of Urology, Guy's Hospital, Great Maze Pond, SE1 9RT, London, UK

    Fahd Khan, Kamran Ahmed, Nikiesha Lee, Ben Challacombe, Mohammed S. Khan & Prokar Dasgupta

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F.K. and N.L. researched data for the article. F.K. and M.S.K. contributed to the discussion of content. F.K. and K.A. wrote the article. F.K., K.A., B.C., M.S.K. and P.D. reviewed/edited the manuscript before submission.

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Khan, F., Ahmed, K., Lee, N. et al. Management of ureteropelvic junction obstruction in adults. Nat Rev Urol 11, 629–638 (2014). https://doi.org/10.1038/nrurol.2014.240

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