Results of selective management of ureteropelvic junction obstruction

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    Abstract

    Background and Purpose: Controversy continues over the need to image the ureteropelvic junction (UPJ) before endopyelotomy to detect crossing vessels. We evaluated a selective management model for UPJ obstruction. Patients and Methods: Intraoperative ultrasonography was performed before endopyelotomy in 19 men and 16 women. Patients with large (>4-mm) crossing vessels underwent open or laparoscopic pyeloplasty; the others had ureteroscopic or percutaneous endopyelotomy with electrocautery or the holmium laser. Results: Crossing vessels were found in 25 of the 35 patients and a high-inserting ureter in 4. The vessels were >4 mm in nine patients, seven of whom had successful pyeloplasty and two of whom were managed expectantly with good results. Endopyelotomy was successful in 94% without a crossing vessel and 70% of those with a crossing vessel. The overall success rate (absence of symptom and resolution of obstruction on renal scintigraphy) was 89%. Conclusion: Selective management of UPJ obstruction, avoiding endopyelotomy in the presence of a large crossing vessel, appears to improve the success rate.

    Original languageEnglish (US)
    Pages (from-to)233-236
    Number of pages4
    JournalJournal of Endourology
    Volume16
    Issue number4
    DOIs
    StatePublished - Jan 1 2002

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    Electrocoagulation
    Solid-State Lasers
    Ureter
    Radionuclide Imaging
    Ultrasonography
    Kidney

    ASJC Scopus subject areas

    • Urology

    Cite this

    Results of selective management of ureteropelvic junction obstruction. / Conlin, Michael.

    In: Journal of Endourology, Vol. 16, No. 4, 01.01.2002, p. 233-236.

    Research output: Contribution to journalArticle

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    abstract = "Background and Purpose: Controversy continues over the need to image the ureteropelvic junction (UPJ) before endopyelotomy to detect crossing vessels. We evaluated a selective management model for UPJ obstruction. Patients and Methods: Intraoperative ultrasonography was performed before endopyelotomy in 19 men and 16 women. Patients with large (>4-mm) crossing vessels underwent open or laparoscopic pyeloplasty; the others had ureteroscopic or percutaneous endopyelotomy with electrocautery or the holmium laser. Results: Crossing vessels were found in 25 of the 35 patients and a high-inserting ureter in 4. The vessels were >4 mm in nine patients, seven of whom had successful pyeloplasty and two of whom were managed expectantly with good results. Endopyelotomy was successful in 94{\%} without a crossing vessel and 70{\%} of those with a crossing vessel. The overall success rate (absence of symptom and resolution of obstruction on renal scintigraphy) was 89{\%}. Conclusion: Selective management of UPJ obstruction, avoiding endopyelotomy in the presence of a large crossing vessel, appears to improve the success rate.",
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