Access the full text.
Sign up today, get DeepDyve free for 14 days.
Loading next page...
/lp/wolters-kluwer-health/pelviureteric-junction-obstruction-in-adults-a-systematic-review-of-93A2Iaj0Gu
- Publisher
- Wolters Kluwer Health
- Copyright
- Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.
- ISSN
- 1661-7657
- eISSN
- 1661-7657
- DOI
- 10.1097/cu9.0000000000000154
- Publisher site
- See Article on Publisher Site
Abstract
Background: Pelviureteric junction obstruction (PUJO) is a common urological disorder that can present at any stage of life. The underlying etiology in children has been well studied; however, a gap exists in the literature for the adult population. Herein, we performed a systematic review of the literature to evaluate the current evidence on the underlying etiologies of adult patients pre- senting with PUJO. Materials and methods: Four electronic databases were searched for relevant studies assessing the underlying etiologies of pelviureteric junction obstruction in adults. Studies were assessed for eligibility based on predefined inclusion and exclusion criteria, and a critical ap- praisal of methodological quality and risk of bias was performed. Finally, qualitative and quantitative data analyses were performed. Results: Twelve studies comprising a total of 513 patients with radiologically confirmed PUJO met the inclusion criteria and were in- cluded in our analysis. The most common finding was crossing vessels, which were observed in 50.5% of patients, followed by intrinsic ureteral stenosis (27.1%), adhesions (15.3%), and high insertion of the ureter (10.1%). Conclusions: The underlying etiologies of PUJO in adults remain unclear. This study indicated that obstruction secondary to crossing vessels is the most common cause of obstruction in adults and occurs more frequently than in the pediatric population. Keywords: Adults; Etiology; Pelviureteric junction obstruction; Ureteropelvic junction obstruction 1. Introduction Various imaging modalities have previously been used to inves- [6,10] tigate and diagnose PUJO. Workup in the adult popula- Pelviureteric junction (PUJ) obstruction is a common urological disor- tion generally consists of contrast-enhanced computed tomogra- der with an incidence of 1 in 1000 to 1500 live births; however, the phy with a delayed urographic phase, to assess the calyceal and [1–3] incidence is not well-defined in adults. Congenital causes are com- vascular anatomy, with dynamic radioisotope renography per- [11] mon, and PUJ obstruction (PUJO) accounts for 5% of antenatal formed to confirm obstruction and assess split renal function. [2] hydronephrosis cases. However, patients may present at any stage Endoluminal evaluation with ureteroscopy and retrograde pyelo- of life, and the most common primary symptom is flank pain, al- graphy has been used to identify malignant urothelial neoplasms [4,5] though PUJO may also be detected incidentally. in select patients, although no series of upper tract urothelial can- Pelviureteric junction obstruction does not represent a single an- cers presenting as suspected PUJO have been reported in the atomical abnormality, but rather a group of obstructive processes literature. that occur secondary to multiple factors, which can be broadly classi- Pyeloplasty remains the standard of care in the treatment of PUJO [6] fied as either intrinsic or extrinsic. Intrinsic causes develop within and may be performed as an open, laparoscopic, or robot-assisted [7,12] the ureter and are usually due to a stenotic or aperistaltic segment, procedure, with success rates of approximately 90%. Endoscopic but may less frequently be due to the presence of ureteric valves or alternatives such as balloon dilatation and endopyelotomy offer a less [5,7] intraluminal lesions. The most common extrinsic cause is an acces- invasive approach for select patients, although their success rates are [7,12] sory crossing vessel, usually an accessory lower-pole renal artery, less favorable than those of pyeloplasty. [5,8] resulting in external compression of the PUJ. Crossing vessels are The underlying etiology of PUJO has been well studied in the pe- a common finding in the unobstructed population, and some contro- diatric population; however, there is a paucity of data in the litera- versy remains regarding how often they are the true cause of obstruc- ture regarding the underlying pathophysiology in the adult popula- [9] [2] tion in patients presenting with PUJO. tion. This systematic review was therefore conducted to evaluate the current evidence on the common underlying etiologies of adult patients presenting with PUJO. *Corresponding Author: Niall J. O'Sullivan, Department of Urology, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland. E-mail address: nosulli7@tcd.ie (N.J. O.'Sullivan). 2. Materials and methods Current Urology, (2023) 17, 2, 86–91 Received May 4, 2022; Accepted July 7, 2022. 2.1. Study design and search strategy http://dx.doi.org/10.1097/CU9.0000000000000154 This study comprised a systematic review of both observational Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. This is and experimental trials and was conducted in accordance with an open-access article distributed under the terms of the Creative Commons the PRISMA (Preferred Reporting Items for Systematic Reviews Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it and Meta-Analyses) reporting guidelines. is permissible to download and share the work provided it is properly cited. The The following search terms were used to identify relevant stud- work cannot be changed in any way or used commercially without permission from the journal. ies: “ureteropelvic* junction obstruction,”“pelviureteric* junction 86 O'Sullivan and Anderson Volume 17 Issue 2 2023 www.currurol.org obstruction,”“etiolog*,”“etiology*,”“adult.” The EMBASE, 2.3. Eligibility criteria MEDLINE, Web of Science, and CINAHL were searched in Original studies on radiologically confirmed PUJO in adult pa- March 2021. Gray literature was also searched to further identify tients were included in the initial screening process. Studies with ongoing research. Finally, the references of all articles satisfying no documented etiology were excluded, as well as individual case the inclusion criteria were analyzed to identify potentially relevant reports. For studies that included both pediatric and adult patients, studies not detected in the online search. only data from adult patients were included in the review. 2.2. Study selection 2.4. Quality assessment and data analysis A database was created using the reference management software A critical appraisal of the methodological quality and risk of bias of Endnote X9™ (Clarivate, UK). Two researchers independently re- the included studies was performed using the Newcastle Ottawa [13] Scale. viewed the outputs from the searches. After removing duplicates, For the included studies that did not report outcomes in studies were independently screened for eligibility by both authors. a manner that enabled us to extract the data for inclusion in this re- Discrepancies were discussed until consensus was reached. Eligibil- view, the authors were contacted, and the raw data were requested. ity was assessed using the predetermined inclusion and exclusion The primary outcome was the underlying cause of obstruction. Sec- criteria, described below. A summary of the screening process is ondary outcomes included the radiological method of diagnosis, treat- shown in the PRISMA flow diagram (Fig. 1). ment modalities used, and success rate following treatment. Figure 1. Study selection. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the selection of relevant publicationsincluded in this review. PUJO = pelviureteric junction obstruction. 87 O'Sullivan and Anderson Volume 17 Issue 2 2023 www.currurol.org Table 1 Methodological characteristics of the included studies. Study Year Country Study design Publication journal Journal impact factor [24] Stern et al. 2007 USA Prospective cohort study The Gold Journal 1.861 [14] Sivaraman et al. 2012 USA Case series The Gold Journal 1.861 [15] Jacobs et al. 1979 USA Case series The Journal of Urology 5.157 [16] Richstone et al. 2009 USA Case series The Gold Journal 1.861 [25] Boylu et al. 2009 USA Retrospective cohort study The Journal of Urology 5.157 [17] Bove et al. 2004 USA Case series The Journal of Urology 5.157 [18] Perlberg and Pfau 1984 Israel Case series The Gold Journal 1.861 [19] Wadsworth and McClennan 1983 USA Case series Urologic Radiology / [23] Lacey and Massouh 2000 UK Prospective cohort study Clinical Radiology 2.350 [20] Schuster et al. 2010 USA Case series Journal of Endourology 2.942 [21] Dajani et al. 1982 Jordan Case series British Journal of Urology 5.588 [22] David and Lavengood 1975 USA Case series The Gold Journal 1.861 2.5. Ethics and data protection The methodological quality of the included studies was satisfac- [14,25] Ethical approval and informed consent were not obtained. The tory (Table 2). The quality was deemed “good” in 2 studies, [16–18,20,23,24] anonymized raw data were encrypted and stored on a password- “satisfactory” in 6 studies, and unsatisfactory in 4 [15,19,21,22] protected computer. The authors declare that they have no con- studies. . flicts of interest in relation to this work. 3.3. Participant characteristics A total of 515 participants were included in the 12 investigated [25] 3. Results studies. Notably, Boylu et al. reported a total of 107 patients with PUJO who underwent robot-assisted laparoscopic dismem- 3.1. Literature search bered pyeloplasty; however, they provided only the demographics The literature search yielded 2545 results. After removing dupli- of 48 patients who were found to have crossing vessels. A total of 9 cates, 1829 studies were screened. After initial screening, 222 ab- studies provided a breakdown based on gender. Women accounted stracts and 28 full texts were reviewed. Of these, 16 were excluded for 53.2% (n = 227) of adults presenting with PUJO, whereas men for the following reasons: 4 did not report etiologies, 4 had no accounted for 46.8% (n = 200). The participant characteristics are breakdown of reported etiologies, 4 did not report on primary summarized in Table 3. PUJO, 3 reported pediatric cases only, and 1 was a case report. Fi- nally, 12 studies met the inclusion criteria. 3.4. Imaging and site of obstruction A total of 513 adults were radiologically confirmed to have PUJO, 3.2. Methodological characteristics and quality of studies and the individual method of imaging was reported in 319 cases. [14–22] Of the 12 studies included, 9 were case series, 2 were prospective Overall, 93.4% (n = 298) of patients underwent more than 1 radio- [23,24] [25] cohort studies, and 1 was a retrospective cohort study. Nine logical investigation as part of their workup. Preoperative use of [14–17,19,20,22,24,25] studies were conducted in the United States, and the MAG-3 renogram was performed in 89% (n = 284)ofpatients [23] the remaining 3 studies were conducted in the United Kingdom, in 4 of the included studies; however, the precise percentage of de- [18] [21] [16,17,23,25] Israel, and Jordan. All the studies were published in English. tection of functional obstruction was not reported. The methodological characteristics of the included studies are sum- The PUJO site was identified in a total of 408 patients. The right marized in Table 1. kidney was affected in 243 cases (59.6%), and the left in 165 cases Table 2 Risk of bias in the included studies. Representativeness of Selection Ascertainment Comparability Outcome Adequacy Study the exposed cohort of control of the exposure (2*) of interest of follow-up Total (/7) [24] Stern et al. */ * / * * 4 [14] Sivaraman et al. */ * * * * 5 [15] Jacobs et al. */ * / / / 2 [16] Richstone et al. */ * / * / 3 [25] Boylu et al. ** * * * * 6 [17] Bove et al. */ * / * * 4 [18] Perlberg and Pfau */ * / / * 3 [19] Wadsworth and McClennan */ * / / / 2 [23] Lacey and Massouh */ * / * * 4 [20] Schuster et al. */ * / * * 4 [21] Dajani et al. */ * / / / 2 [22] David and Lavengood // * / * / 2 The asterisk symbol (*) indicates that the study was satisfactory for the corresponding category, whereas the slash symbol (/) indicates that the study was unsatisfactory. 88 O'Sullivan and Anderson Volume 17 Issue 2 2023 www.currurol.org Table 3 Patient characteristics in the included studies. Study No. of participants Adults (>16) Children Females Males Age range, yr [24] Stern et al. 10 10 0 ‐‐ 18–61 [14] Sivaraman et al. 168 168 0 94 74 19–71 [15] Jacobs et al. 5 5 041 21–62 [16] Richstone et al. 155 155 0 84 71 10–85 [25] Boylu et al. 107 107 0 ‐‐ 19–53 [17] Bove et al. 11 11 0 4 7 25–60 [18] Perlberg and Pfau 4 3 112 20–36 [19] Wadsworth and McClennan 5 5 023 37–62 [23] Lacey and Massouh 19 19 0 7 12 18–63 [20] Schuster et al. 9 9 045 20–60 [21] Dajani et al. 5 4 104 20–37 [22] David and Lavengood 17 17 0 ‐‐ ‐ Total 515 513 2 227 200 (40.4%). This finding contrasts with the literature, which suggests 11 patients, PUJO was caused by crossing vessels in 5, high ureteral [4] that PUJO more commonly affects the left kidney. insertion in 3, and ureteral stenosis in 3 cases. Wadsworth and [19] McClennan discovered a number of rare etiologies in an inves- 3.5. Underlying etiology tigation of 5 patients presenting with PUJO. These included ob- The underlying cause of obstruction was reported in 513 adults. struction secondary to crossing vessels, external compression from Overall, crossing vessels were the most frequently reported etiol- an abdominal aortic aneurysm, and rotation of the kidney due to a ogy; however, a detailed breakdown of the underlying causes renal cyst, eosinophilic ureteritis, or xanthogranulomatous pyelo- [24] [20] was often not available. The underlying etiology was diagnosed nephritis. Schuster et al. published the intraoperative findings preoperatively using imaging, intraoperatively, or postoperatively of 9 patients undergoing laparoscopic pyeloplasty for PUJO. They using histology. discovered crossing vessels in 7 cases, retroperitoneal fibrosis in 3, Five studies included in our review did not report a breakdown and periureteral adhesions in 6, with a number of patients having [20] of the individual causes of PUJO in their cohorts and instead cate- multiple intraoperative findings. In the small series by Perlberg [18] gorized patients into obstruction secondary to crossing vessels, in- and Pfau, all 3 cases of obstruction presented were attributed [25] [21] trinsic causes, or “other.” Boylu et al. observed anterior cross- to crossing vessels. All 4 cases in the series by Dajani et al. oc- ing vessels in 48 of 107 patients (44.9%). In another large study curred secondary to congenital ureteric valves. Finally, in a series [14] [22] by Sivaraman et al., crossing vessels were diagnosed in 75 of of 17 patients with PUJO reported by David and Lavengood, 168 cases (44.6%). The underlying diagnosis of the remaining 93 the causative factor was crossing vessels in 2, periureteral adhe- patients was noted only as “intrinsic pathology”. Lacey and sions in 3, ureteric stenosis in 9, and high insertion of the ureter [23] Massouh used multiplanar computed tomography imaging to in 3 cases. Overall, for the 59 patients in whom a detailed descrip- identify crossing vessels in 14 of 19 patients, or 73.7% of cases; tion of the underlying cause of obstruction was provided, crossing the underlying etiology of the remaining 5 patients was not vessels were the most common cause, accounting for 41% of the [15] discussed. In Jacobs and colleagues' small series of 5 cases of cases, followed by ureteral stenosis (27%) and adhesions (15%) PUJO, all 5 were attributed to intrinsic causes. Finally, Richstone (Table 5). [16] et al. found crossing vessels in 98 of 155 patients presenting with PUJO (63.2%). The etiology of the remaining 57 patients 3.6. Treatment method and outcome was not reported. These findings are presented in Table 4. The surgical outcomes were discussed in 6 of the included [14,17–20,24] Seven studies included in our review provided a detailed break- studies. These findings are presented in Table 6. In sum- [24] down of the underlying cause of obstruction in patients presenting mary, Stern et al. reported a 100% success rate in 6 patients [24] with PUJO. Stern et al. discovered crossing vessels in 6 of the 10 who underwent laparoscopic pyeloplasty, all of whom had cross- patients included in their study. Although the etiology of the re- ing vessels reported as the cause of obstruction. In this series, suc- maining 4 cases was not reported in the original article, after cess was defined as the resolution of the obstruction on the contacting the authors, we were informed that the etiology of all Whitaker test. A success rate of 97.6% was reported by Sivaraman [17] [14] 4 cases was ureteral stenosis. In a study by Bove et al. involving et al. in their study examining the outcomes of robot-assisted laparoscopic dismembered pyeloplasty in a cohort of 164 patients with PUJO. In this study, success was defined as resolution of ob- Table 4 struction on follow-up imaging at a mean interval of 39 months Studies lacking individual breakdown of etiologies. postoperatively. Four patients in this series were deemed to have unsuccessful outcomes as they required further procedures. Eleven Study No. of patients Crossing vessels Intrinsic Undocumented patients (6.6%) developed postoperative complications, including [14] [17] [25] primarily ileus and the need for blood transfusion. Bove et al. Boylu et al. 107 48 ‐ 59 [14] Sivaraman et al. 168 75 93 ‐ reported a success rate of 90.9% in their study of 11 patients un- [23] Lacey and Massouh 19 14 ‐ 5 dergoing laparoscopic pyeloplasty for PUJO. Success was defined [15] Jacobs et al. 50 5 ‐ as the resolution of symptoms at a mean follow-up of 32.6 months. [16] Richstone et al. 155 98 ‐ 57 [19] Wadsworth and McClennan defined success as the resolution Total 454 235 98 121 of PUJO on postoperative imaging. Their series included 5 patients 89 O'Sullivan and Anderson Volume 17 Issue 2 2023 www.currurol.org Table 5 Studies with individual breakdown of etiologies. Study No. of patients Crossing vessels Ureteral stenosis High insertion Adhesions Congenital valves Other [24] Stern et al. 10 6 4 ‐‐ ‐ ‐ [17] Bove et al. 11 5 3 3 ‐‐ ‐ [19] Wadsworth and McClennan 51 ‐‐ ‐ ‐ 4 [20] Schuster et al. 97 ‐‐ 6 ‐ 3 [18] Perlberg and Pfau 33 ‐‐ ‐ ‐ ‐ [21] Dajani et al. 4 ‐‐ ‐ ‐ 4 ‐ [22] David and Lavengood 17 2 9 3 3 ‐‐ Total 59 24 16 6 9 4 7 who underwent 4 different types of surgical treatment because of a va- An understanding of the underlying etiology of PUJO is important riety of underlying etiologies. Resolution of obstruction was observed for establishing treatment methods, and outcomes may vary, depend- [20] in all 5 cases. Schuster et al. reported successful outcomes in 77.8% ing on the underlying diagnosis. The presence of a crossing vessel has [24] of patients who underwent laparoscopic pyeloplasty for PUJO. Suc- also been shown to negatively affect the surgical success rate. Van [27] cess was defined as either absence of pain, a t of less than 20 minutes Cangh et al. found that the success rates for endopyelotomy were on diuretic renogram, or no requirement of any further procedures. significantly lower when a crossing vessel was implicated than when Two patients in this series were deemed to have unsuccessful out- no crossing vessels were present (33% vs. 82%). comes, as they experienced persistent pain postoperatively and re- Although histological analysis of the stenotic PUJ segment was in- [20] [26,28] [16] quired a second procedure to treat their obstruction. Finally, frequently reported in our review, Richstone et al. compared [18] Perlberg and Pfau reported resolution of obstruction on postoper- the histologic findings of PUJO in those with and without crossing ative imaging in all 3 of their cases of vessel transection in the manage- vessels. Of the 95 cases sent for histological analysis, 65 showed cross- ment of PUJO. Of note, no endoscopic treatment methods were used ing vessels, and 30 did not. The majority of patients with crossing ves- in the included studies. This is likely because they failed to meet our sels had no intrinsic abnormality detected histologically, whereas inclusion criteria for reporting the underlying cause of obstruction. 90% of those without crossing vessels had an intrinsic histological ab- normality, the most common finding being chronic inflammation [29] (40%). Conversely, in a study by Cancian et al., chronic inflamma- 4. Discussion tion was observed in histology specimens more often in those with crossing vessels than in those with intrinsic etiologies. This may ex- The etiology of PUJO in adults is understudied compared with that plain the rarity of PUJO secondary to crossing vessels in newborns [26] in the pediatric population. Crossing vessels are a common find- and the comparatively high incidence observed in our review of the [29] [30] ing in patients with PUJO undergoing pyeloplasty, both on imag- adult population. Weiss et al. reported the detection of crossing ing and intraoperatively. However, evidence concerning the extent vessels in 166 pediatric patients; although the overall rate of crossing to which crossing vessels contribute to the development of obstruc- vessels (47%) was similar to the rate seen in our review of adult pa- tion remains contradictory, and few studies have previously re- tients, the median age of patients undergoing surgery was significantly [8] ported the histological findings of excised PUJ segments. In our higher for patients with crossing vessels (8.2 years) than for those review, of the 513 adults presenting with radiologically confirmed without (0.9 years), suggesting that crossing vessels become more clin- [30] PUJO, crossing vessels were found in 259 cases (50.5%). Of those ically significant with age. without crossing vessels, an individual breakdown of etiology was To our knowledge, this is the first systematic review investigating reported in only 35 patients, several of whom were found to have the underlying etiologies of PUJO in adults. However, our study had multiple pathologies on histological analysis (16 intrinsic stenoses, a number of limitations, which should be discussed. Despite an ex- 6 high insertions of ureter, 9 adhesions, 4 congenital valves, and 7 tensive literature search and broad inclusion criteria, there is a dis- reported as “other”). tinct lack of studies reporting the underlying cause of PUJO in Table 6 Treatment outcomes. Outcome Mean Study Treatment reported follow-up, mo Definition of success Successful Unsuccessful Complications [24] Stern et al. LP 6 ‐ Whitaker pressure reduction 6 (100%) 0 ‐ [14] Sivaraman et al. RALP 168 39 Resolution on imaging 164 (97.6%) 4—needed 2nd procedure 11 (6.6%) [17] Bove et al. LP 11 32.6 “Asymptomatic” 10 (90.9%) 1—no decrease in RFT 2 (18.1%) Wadsworth and 2xLP 5 ‐ Resolution on imaging 5 (100%) 0 ‐ [19] McClennan 3 x other [20] Schuster et al. LP 9 21.5 No pain 7 (77.8%) 2—persistent pain, need 2(22.2%) t <20 mo on DR for 2nd procedure No 2nd procedure [18] Perlberg and Pfau Vessel transection 3 10 Resolution on imaging 3 (100%) 0 ‐ DR = diuretic renogram ; LP = laparoscopic pyeloplasty; RALP = robotic-assisted laparoscopic pyeloplasty, RFT = renal function tests. 90 O'Sullivan and Anderson Volume 17 Issue 2 2023 www.currurol.org adults. Consequently, the final sample size was relatively small. This [6] Anderson KR, Weiss RM. Physiology and evaluation of ureteropelvic junction obstruction. JEndourol 1996;10(2):87–91. is particularly relevant for the quantitative summary, because al- [7] Elmussareh M, Traxer O, Somani BK, Biyani CS. Laser endopyelotomy in though there are a large number of studies on PUJO, the majority the management of pelviureteric junction obstruction in adults: A were excluded as they failed to provide details on the underlying systematic review of the literature. Urology 2017;107:11–22. cause of obstruction. Furthermore, there was a high degree of het- [8] Lawler LP, Jarret TW, Corl FM, Fishman EK. Adult ureteropelvic junction obstruction: Insights with three-dimensional multi-detector row CT. erogeneity in the reporting of data, including variability in the defini- Radiographics 2005;25(1):121–134. tion of “success” of treatment methods, further limiting the external [9] Sampaio FJ, Favorito LA. Ureteropelvic junction stenosis: Vascular anatomical validity of the pooled data. background for endopyelotomy. JUrol 1993;150(6):1787–1791. [10] Ucar AK, Kurugoglu S. Urinary ultrasound and other imaging for ureteropelvic junction type hydronephrosis (UPJHN). Front Pediatr 2020;8:546. [11] Wong JC, Rossleigh MA, Farnsworth RH. Utility of technetium-99 5. Conclusions m-MAG3 diuretic renography in the neonatal period. J Nucl Med 1995; 36(12):2214–2219. This study is the first systematic review of PUJO in adults. Despite [12] Varkarakis IM, Bhayani SB, Allaf ME, et al. Management of secondary the elaborate search strategy, study heterogeneity and overall ureteropelvic junction obstruction after failed primary laparoscopic pyeloplasty. JUrol 2004;172(1):180–182. underreporting of the underlying etiologies in many studies limited [13] Wells GA, Shea B, O'connell D, et al. The Newcastle-Ottawa scale (NOS) our ability to perform an accurate pooled analysis. Despite these lim- for assessing the quality of nonrandomised studies in meta-analyses. The itations, we were able to identify that extrinsic compression second- Ottawa Hospital Research Institute. Avaliable at: https://www.ohri.ca/ ary to crossing vessels is the most commonly reported cause of PUJO programs/clinical_epidemiology/oxford.asp. in adults, present in greater than 50% of cases, and is seen more fre- [14] Sivaraman A, Leveillee RJ, Patel MB, et al. Robot-assisted laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction: A quently than in the pediatric population. Further prospective studies multi-institutional experience. Urology 2012;79(2):351–355. combining radiological and histological data in adult patients under- [15] Jacobs JA, Berger BW, Goldman SM, Robbins MA, Young JD Jr. going treatment for PUJO are required to strengthen the findings of Ureteropelvic obstruction in adults with previously normal pyelograms: this study, which investigated a relatively underresearched topic. A report of 5 cases. JUrol 1979;121(2):242–244. [16] Richstone L, Seideman CA, Reggio E, et al. Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology Acknowledgments 2009;73(4):716–719 discussion 719. [17] Bove P, Ong AM, Rha KH, Pinto P, Jarrett TW, Kavoussi LR. None. Laparoscopic management of ureteropelvic junction obstruction in patients with upper urinary tract anomalies. J Urol 2004;171(1):77–79. [18] Perlberg S, Pfau A. Management of ureteropelvic junction obstruction Statement of ethics associated with lower polar vessels. Urology 1984;23(1):13–18. [19] Wadsworth DE, McClennan BL. Benign causes of acquired ureteropelvic Not applicable. Ethical approval and informed consent were not junction obstruction: A uroradiologic spectrum. Urol Radiol 1983;5(2):77–82. obtained. The anonymized raw data were encrypted and stored [20] Schuster TK, Jacobs BL, Gayed BA, Averch TD. Preliminary experience with laparoscopic ureteropelvic junction release in the treatment of on a password-protected computer. ureteropelvic junction obstruction. JEndourol 2010;24(3):393–396. [21] Dajani AM, Dejani YF, Dahabrah S. Congenital ureteric valves—Acause Conflict of interest statement of urinary obstruction. Br J Urol 1982;54(2):98–102. [22] David HS, Lavengood RW Jr. Ureteropelvic junction obstruction in No conflict of interest has been declared by the author. nephrolithiasis. An etiologic factor. Urology 1975;5(2):188–190. [23] Lacey NA, Massouh H. Use of helical CT in assessment of crossing vessels in pelviureteric junction obstruction. Clin Radiol 2000;55(3):212–216. Funding source [24] Stern JM, Park S, Anderson JK, Landman J, Pearle M, Cadeddu JA. Functional assessment of crossing vessels as etiology of ureteropelvic None. junction obstruction. Urology 2007;69(6):1022–1024. [25] BoyluU,OommenM,Lee BR, ThomasR.Ureteropelvic junction obstruction secondary to crossing vessels-to transpose or not? The robotic Author contributions experience. JUrol 2009;181(4):1751–1755. [26] Kajbafzadeh AM, Payabvash S, Salmasi AH, Monajemzadeh M, Tavangar NOS: Study design, data extraction and synthesis, manuscript SM. Smooth muscle cell apoptosis and defective neural development in writing, corrections; congenital ureteropelvic junction obstruction. J Urol 2006;176(2): 718–723 discussion 723. SA: Study design, manuscript writing, corrections, final review. [27] Van Cangh PJ, Nesa S, Galeon M, et al. Vessels around the ureteropelvic junction: Significance and imaging by conventional radiology. JEndourol References 1996;10(2):111–119. [28] Hosgor M, Karaca I, Ulukus C, et al. Structural changes of smooth muscle [1] Pickersgill NA, Wright AJ, Figenshau RS. Ureteropelvic junction in congenital ureteropelvic junction obstruction. J Pediatr Surg 2005;40 obstruction caused by metastatic cholangiocarcinoma. Int Braz J Urol (10):1632–1636. 2019;45(6):1266–1269. [29] Cancian M, Pareek G, Caldamone A, Aguiar L, Wang H, Amin A. [2] Grasso M, Caruso RP, Phillips CK. UPJ obstruction in the adult Histopathology in ureteropelvic junction obstruction with and without population: Are crossing vessels significant? Rev Urol 2001;3(1):42–51. crossing vessels. Urology 2017;107:209–213. [30] Weiss DA, Kadakia S, Kurzweil R, Srinivasan AK, Darge K, Shukla AR. Detection [3] Al Aaraj MS, Badreldin AM. Ureteropelvic Junction Obstruction. Treasure of crossing vessels in pediatric ureteropelvic junction obstruction: Clinical patterns Island: StatPearls Publishing; 2022. and imaging findings. JPediatr Urol 2015;11(4):173.e1–173.e5. [4] Williams B, Tareen B, Resnick MI. Pathophysiology and treatment of ureteropelvic junction obstruction. Curr Urol Rep 2007;8(2):111–117. [5] Castaneda F, Hernandez-Graulau JM. Percutaneous endopyelotomy for How to cite this article: O'Sullivan NJ, Anderson S. Pelviureteric junction the treatment of ureteropelvic junction obstruction. Semin Intervent obstruction in adults: A systematic review of the literature. Curr Urol Radiol 1996;13(2):169–183. 2023;17(2):86–91. doi: 10.1097/CU9.0000000000000154
Journal
Current Urology – Wolters Kluwer Health
Published: Jun 28, 2023