The Operative Management of Recurrent Ureteropelvic Junction Obstruction

Abstract

No AccessJournal of UrologyHydronephrosis/Duplex Ureter1 Sep 1997The Operative Management of Recurrent Ureteropelvic Junction Obstruction Dorothea Rohrmann, Howard M. Snyder, John W. Duckett, Douglas A. Canning, and Stephen A. Zderic Dorothea RohrmannDorothea Rohrmann , Howard M. SnyderHoward M. Snyder , John W. DuckettJohn W. Duckett , Douglas A. CanningDouglas A. Canning , and Stephen A. ZdericStephen A. Zderic View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64446-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Surgical repair of ureteropelvic junction obstruction is successful in 98% of cases. We evaluated children undergoing repeat pyeloplasty and discuss the etiology of recurrent ureteropelvic junction obstruction, surgical approach and outcome. Materials and Methods: Between 1982 and 1996, 366 children with ureteropelvic junction obstruction were surgically treated at our institution, including 16 who presented with recurrent ureteropelvic junction obstruction and required surgery. Results: Repeat repair was successful in all 16 patients, including ureterocalicostomy in 3 and dismembered pyeloplasty in the remainder. No nephrectomy was necessary. Anteriorly elongated flank incisions were made in all cases. Dense scar tissue around and obstructing the ureteropelvic junction was noted in the majority of cases. In 7 patients a redundant pelvis resulted in a kink at the ureteropelvic junction. A nephrostomy tube was placed in all cases and an additional transanastomotic stent was used in all but 2. Obstruction was relieved with 1 operation. Conclusions: A redundant pelvis resulting in a kink at the ureteropelvic junction may contribute to a higher chance of urinary leakage and subsequent obstructive scar formation in cases of failed pyeloplasty. Before repeat surgery anatomy should be precisely identified by antegrade and retrograde studies. The surgical approach usually involves identifying the ureter below the area of the previous surgery and then ensuring a tension-free anastomosis. If inadequate ureteral length or an intrarenal pelvis precludes direct anastomosis, ureterocalicostomy is an alternative. A nephrostomy tube and transanastomotic stent are advisable. Nephrectomy is rarely necessary and a good functional result can be anticipated. References 1 : Obstruction at the ureteropelvic junction.. In: The Ureter. Edited by . New York: Springer-Verlag1981: 697. chapt. 33. Google Scholar 2 : Endopyelotomy for secondary ureteropelvic junction obstruction in children.. J. Urol.1991; 145: 345. 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Google Scholar From the Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byParente A, Angulo J, Burgos L, Romero R, Rivas S and Ortiz R (2015) Percutaneous Endopyelotomy over High Pressure Balloon for Recurrent Ureteropelvic Junction Obstruction in ChildrenJournal of Urology, VOL. 194, NO. 1, (184-189), Online publication date: 1-Jul-2015.Braga L, Lorenzo A, Bägli D, Keays M, Farhat W, Khoury A and Salle J (2008) Risk Factors for Recurrent Ureteropelvic Junction Obstruction After Open Pyeloplasty in a Large Pediatric CohortJournal of Urology, VOL. 180, NO. 4S, (1684-1688), Online publication date: 1-Oct-2008.Braga L, Lorenzo A, Skeldon S, Dave S, Bagli D, Khoury A, Pippi Salle J and Farhat W (2007) Failed Pyeloplasty in Children: Comparative Analysis of Retrograde Endopyelotomy Versus Redo PyeloplastyJournal of Urology, VOL. 178, NO. 6, (2571-2575), Online publication date: 1-Dec-2007. Volume 158Issue 3September 1997Page: 1257-1259 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Dorothea Rohrmann More articles by this author Howard M. Snyder More articles by this author John W. Duckett More articles by this author Douglas A. Canning More articles by this author Stephen A. Zderic More articles by this author Expand All Advertisement PDF downloadLoading ...