Coexisting ureteropelvic junction obstruction and ureterovesical junction obstruction: is pyeloplasty always the preferred initial surgery?
OBJECTIVE
To report our experience with the diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and ureterovesical junction obstruction (UVJO).


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.


CONCLUSIONS
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.
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yong Seung
YS
Lee
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Young Jae
YJ
Im
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Hyeyoung
H
Lee
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
Myung-Joon
MJ
Kim
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
Mi-Jung
MJ
Lee
Department of Urology, Catholic University of Daegu School of Medicine, Daegu, Korea.
Hyun Jin
HJ
Jung
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address: swhan@yuhs.ac.
Sang Won
SW
Han
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D014517:Ureteral Obstruction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D001743:Urinary Bladder; D013520:Urologic Surgical Procedures / Q000379:methods