Hydronephrosis in the course of ureteropelvic junction obstruction - an underestimated problem?Current opinion on pathogenesis, diagnosis and treatment.

Abstract

Ureteropelvic junction obstruction (UPJO) causes a reduction in the urine flow from the renal pelvis into the ureter. Untreated UPJO may cause hydronephrosis, chronic infection or urolithiasis and will often result in progressive deterioration of renal function. Most cases of UPJO are congenital; however, the disease can be clinically silent until adulthood. Other causes, both intrinsic and extrinsic, are acquired and include urolithiasis, post-operative/inflammatory/ischemic stricture, fibroepithelial polyps, adhesions and malignancy. In the past, the most frequent symptom of UPJO in neonates and infants was a palpable flank mass. Nowadays, thanks to the widespread use of maternal and prenatal ultrasound examinations, asymptomatic hydronephrosis is diagnosed very early. In adults and older children symptoms may include intermittent abdominal or flank pain, nausea, vomiting and hematuria. In addition to high specificity and sensitivity in detecting UPJO, modern technologically advanced equipment such as ultrasound, magnetic resonance imaging and computed tomography provides a lot of information about the function of the affected kidney and the anatomy of the surrounding tissues. Treatment options for UPJO include a wide spectrum of approaches, from active surveillance or minimally invasive endourologic techniques to open, laparoscopic or robotic pyeloplasty. The main goal of therapy is to relieve symptoms and maintain or improve renal function, but it is difficult to define treatment success after UPJO therapy.

Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide

“…14,15 However despite this association, the relationship between crossing vessels and UPJO is unclear. 16…”

A correlation study of the effectiveness of renal scintigraphy and sonography in the detection and evaluation of renal disorders

“…Renal scintigraphy scan is a preferred diagnostic test to estimate GFR and blood ow in kidneys [20]. In most of the cases, renal US are effective to identify urinary tract abnormalities but not prioritized for renal parenchymal diagnosis [21].…”

The Role of Imaging in Diagnosis of Urolithiasis and Nephrolithiasis—A Literature Review Article

“…The bladder cans stretch and once full we urinate; the urine will flow through the urethra and then out. The ureter has three sites of constriction where it contracts smooth muscle and these are important to know because these are the sites where narrowing can occur and also the site where urinary stones can lodge the sites of ureter constriction including the pelvic ureteric junction [3], the pelvic brim and the vesicoureteric junction [4]. Vesicoureteric junction is actually the connection between the ureter and the urinary bladder which is sort behind and beneath the urinary bladder.…”