UPJO

1. UPJO…. where we are?
AHMED OSHIBA,
ASSISTANT LECTURER PEDIATRIC SURGERY AND UROLOGY DEPARTMENT
ALEXANDRIA, EGYPT

2. 1:750 - 1500 live
births.
11% of antenatal
hydronephrosis.

4. What pre-operative
investigations do you
perform?

5. Renal ultrasound.
MAG3 renogram.
DTPA.
DMSA.
VCUG ????

8. What are your
indications for surgery?

9. Differential function (DF) of less than 40%.
Symptoms attributable to a UPJO.
A washout curve greater than T1/2 > 20 min, if in conjunction with poor
function or symptoms.
Associated with calyceal dilatation, thinned parenchyma: severe
anteroposterior (AP) diameter > 40 mm (even with symmetric function).

10. Do you perform a VCUG if the pre-
operative RUS appears to be a typical
UPJ obstruction?

11. What features make you suspect an
extrinsic cause of obstruction?
Do you perform any addition preoperative
investigations in this situation?

12. LPCVS
Age.
clinical history, pain.
fluctuation of hydronephrosis.
MRU/ CT/ Color doppler.

13. What is your approach to UPJO with <10%
function on renogram?
Do you perform an initial nephrostomy or insert a
double J (DJ) stent to assess recoverability of
function?

14. conservative.
nephrostomy.
JJ stenting.
Nephrectomy.
Pyeloplasty.

15. Preferred Approach

16. 15 – 30 cases
Open ( flank vs dorsal lumbotomy)
Transperitoneal laparoscopy.
Retroperitoneal laparoscopy.
Robotic assisted.

17. Do you actively reduce the
size of the pelvis during
a pyeloplasty?

19. What type of stent, if any, do
you use after a pyeloplasty
and why?

20. Blue stent. JJ stent. Stenteless.

22. Do you drain the bladder
after a pyeloplasty? If so,
for how long?

24. Post-operative follow-up