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Coexisting ureteropelvic junction obstruction and ureterovesical junction obstruction: is pyeloplasty always the preferred initial surgery?

 Yong Seung Lee  ;  Young Jae Im  ;  Hyeyoung Lee  ;  Myung-Joon Kim  ;  Mi-Jung Lee  ;  Hyun Jin Jung  ;  Sang Won Han 
 UROLOGY, Vol.83(2) : 443-449, 2014 
Journal Title
Issue Date
Child ; Child, Preschool ; Female ; Humans ; Infant ; Kidney Pelvis/surgery* ; Male ; Retrospective Studies ; Ureteral Obstruction/complications* ; Ureteral Obstruction/diagnosis ; Ureteral Obstruction/surgery* ; Urinary Bladder* ; Urologic Surgical Procedures/methods
OBJECTIVE: To report our experience with the diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and ureterovesical junction obstruction (UVJO). MATERIALS AND METHODS: Among the pediatric patients who underwent pyeloplasty or ureteroneocystostomy from 2003-2012, 15 patients were diagnosed with coexisting UPJO and UVJO. We retrospectively analyzed their medical records. RESULTS: Of the 15 patients with coexisting UPJO and UVJO, the correct diagnosis was made preoperatively in 10 patients (66.7%). In 4 other patients, only UPJO was diagnosed, and in 1 patient, only UVJO was diagnosed. The decision of where to initially operate was determined from the combined results of the preoperative antegrade evaluation and retrograde ureteropyelography. Pyeloplasty was the initial surgical management choice for 9 patients, and ureteroneocystostomy was the initial surgical approach in 5 patients. In 1 patient, both pyeloplasty and ureteroneocystostomy were performed simultaneously. Of the 9 patients who underwent initial pyeloplasty, additional ureteroneocystostomy was required in 2. Additional pyeloplasty was required in 2 of the 5 patients who initially underwent ureteroneocystostomy. CONCLUSION: It is often difficult to correctly diagnose coexisting UPJO and UVJO. In patients with UPJO, it is highly recommended that retrograde ureteropyelography be performed before pyeloplasty to evaluate the distal ureter-ureterovesical junction. Initial pyeloplasty is not always recommended as a first-line therapy.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myung Joon(김명준) ORCID logo https://orcid.org/0000-0002-4608-0275
Lee, Mi-Jung(이미정) ORCID logo https://orcid.org/0000-0003-3244-9171
Lee, Yong Seung(이용승) ORCID logo https://orcid.org/0000-0003-3778-9888
Lee, Hye Young(이혜영)
Im, Young Jae(임영재)
Jung, Hyun Jin(정현진)
Han, Sang Won(한상원) ORCID logo https://orcid.org/0000-0003-0941-1300
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