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The coexistence of ureteropelvic junction obstruction and reflux

R L Lebowitz, J G Blickman

    AJR. American Journal of Roentgenology
    |February 1, 1983
    PubMed

    Insights

    Ureteropelvic junction obstruction and vesicoureteral reflux can coexist in children. Diagnosis requires specific imaging, and surgical order (pyeloplasty first) is crucial for successful treatment.

    Area of Science:

    • Pediatric Urology
    • Diagnostic Imaging
    • Surgical Management

    Background:

    • Ureteropelvic junction obstruction (UPJO) is the most common upper urinary tract anomaly in children.
    • Vesicoureteral reflux (VUR) is the most common lower urinary tract anomaly in children.
    • The coexistence of UPJO and VUR is uncommon but clinically significant.

    Observation:

    • This study observed 21 cases of coexisting UPJO and VUR over a 10-year period.
    • Significant UPJO with mild VUR can mimic severe VUR, necessitating pyeloplasty over reimplantation.
    • Significant UPJO and significant VUR may require both surgical interventions.

    Findings:

    • The order of surgical intervention is critical when both UPJO and VUR are present; pyeloplasty should be performed first.
    • Diagnostic imaging, including voiding cystography and excretory urography (with diuretic challenges if needed), is essential for accurate diagnosis and severity assessment.
    • Imaging techniques help differentiate between isolated UPJO, isolated VUR, and the combined condition.

    Implications:

    • Accurate diagnosis and appropriate surgical sequencing are vital for optimal outcomes in children with combined UPJO and VUR.
    • Understanding the interplay between these conditions improves surgical planning and patient management.
    • This knowledge aids pediatric urologists in selecting the correct surgical approach, avoiding unnecessary procedures, and ensuring effective treatment.

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