UPJ obstruction ,causes and management done by dr mustafa majid

2. With UPJ obstruction ,there is
inadequate drainage of urine from
renal pelvis,resulting in hydrostatic
distention of pelvis and intrarenal
calyces.the combination of increased
intrapelvic pressure and urine stasis in
the collecting ducts results in
progressive damage to the kidney

3. Incidence of UPJ obstruction 15000 live births
More common in boys 2:1
Two third on left side
Bilateral obstruction is much less common

4. Failure of ureter to recanalized
completely during development of
upper part ,is thought to be the
cause of most intrinsic UPJ
obstructions ,other causes ,ureteral
valves ,polyps, leiomyoma

5. Prenataly :most renal dilation and obstruction
detected by abd us
Abd mass,UTI,or discover accidently during
screening for other congenital anomalies
(VACTRAL)
In older children ,vague ,poorly localized,cyclic
Or acute abdominal pain associated with nausea
is common (dietl crisis)
Hematuria after minor trauma or vigorous
exercise

6.  Abdominal us :pelvic and calyceal dilation with
variable thining of renal parenchyma .
 The presence of coticomedullary junctions is
indicative of preserved function
 VCUG
 Diuretic isotopic renogram : is very useful for
evaluating hydronephrosis ,differential renal
function ,renal drainge .
 MRU
 Invasive pressure flow studies
 Retrograde urography

16. Observation until the surgical intervention is
indicated
Indications of surgery
1-intermittent obstruction and pain
2-diminish renal function in presence of an
obstructive pattern in renography
3-renal function <35-40% in hydronephrotic
kideny

17. 1-relieve of obstruction
2-imorove renal function
3-maintain the normal
development

18. Surgical correction of UPJ obstruction is
dismembered pyeloplasty
Open pyeloplasty.
Endoscopic approach(endopylotomy)for UPJ
obstruction which is antegrade or retrograde
Laparoscopic pyeloplasty (anderson-hynes )

19.  We had 3 types of incisions
 1-standard flank
 2-anterior subcostal
 3-dorsal lumbotomy
 Types of pyeloplasty
 1-anderson-hynes dismembered pyeloplasty
 2-scardino-price vertical flap pyeloureteroplasty
 3-clup-deweerd spiral flap ureteropelvioplasty
 4-foley Y-V plasty

29. The most common early complications
are prolong urinary extravasation and
delayed drainage through anastomosis
Recurrent UPJ obstruction <1%
Nephrectomy rate <2%
Anastomotic leakage

30. Functional assessment of
anastomosis with nuclear
renography is obtained 2-3
months after operation ,and 12-
24 months another evaluation
after surgery