Pelviureteric junction obstruction in association with severe vesicoureteric reflux: a diagnostic dilemma

Three patients are described who present the diagnostic and management dilemma of having a definite obstruction at the pelviureteric junction in association with marked vesicoureteric reflux. It is not always a simple decision as to whether the hydronephrosis should be operated upon before reflux or vice versa. The decision is based on an assessment of the severity of the reflux and the radiological or other interpretation of obstruction at the pelviureteric junction. Some guidelines are given and the management of the 2 conditions when occurring together is discussed.