Results of selective management of ureteropelvic junction obstruction.
OBJECTIVE
Controversy continues over the need to image the ureteropelvic junction (UPJ) before endopyelotomy to detect crossing vessels. We evaluated a selective management model for UPJ obstruction.


METHODS
Intraoperative ultrasonography was performed before endopyelotomy in 19 men and 16 women. Patients with large (>4-mm) crossing vessels underwent open or laparoscopic pyeloplasty; the others had ureteroscopic or percutaneous endopyelotomy with electrocautery or the holmium laser.


RESULTS
Crossing vessels were found in 25 of the 35 patients and a high-inserting ureter in 4. The vessels were >4 mm in nine patients, seven of whom had successful pyeloplasty and two of whom were managed expectantly with good results. Endopyelotomy was successful in 94% without a crossing vessel and 70% of those with a crossing vessel. The overall success rate (absence of symptom and resolution of obstruction on renal scintigraphy) was 89%.


CONCLUSIONS
Selective management of UPJ obstruction, avoiding endopyelotomy in the presence of a large crossing vessel, appears to improve the success rate.
Conlin
Michael J
MJ
Division of Urology and Renal Transplantation, Oregon Health Sciences University, Portland, Oregon 97201-3098, USA. colinnm@ohsu.edu
D000293:Adolescent; D000328:Adult; D000368:Aged; D001808:Blood Vessels; D002648:Child; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D010535:Laparoscopy; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000098:blood supply; D014517:Ureteral Obstruction / Q000175:diagnosis / Q000601:surgery*; D018666:Ureteroscopy; D014567:Urography; D013520:Urologic Surgical Procedures