Ureteropelvic junction obstruction after partial nephrectomy

As the experience with partial nephrectomy continues to grow and the procedure increasingly becomes the standard of care for properly selected patients, it is critical to understand the potential complications and how these complications are best managed. Presented herein is the presentation, work-up, and treatment of ureteropelvic junction (UPJ) obstruction after partial nephrectomy.

From 1993 to 2004, 1154 partial nephrectomies have been performed at our institution by one surgeon. From the database of these patients, four (0.35%) were identified with postoperative UPJ obstruction. The charts of these patients were reviewed to identify preoperative and intraoperative characteristics as they relate to the development and risk of UPJ obstruction. Additionally, the presentation of UPJ obstruction, its management, and long-term follow-up are reported.

Tumor location in the lower pole appears to be a risk factor for the development of UPJ obstruction, which is likely a result of ischemic or mechanical injury. This complication was managed successfully by endoscopic approaches in three of four cases. At a mean follow-up of 43 months, all patients remain free of obstruction according to both the absence of symptoms and radiographic evidence.

Obstruction of the UPJ is an uncommon complication of partial nephrectomy. Endoscopic treatment of this complication yields a durable outcome, as all patients with a mean follow-up of more than 3 years show resolution of their obstruction.