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UPJ obstruction - Coggle Diagram
UPJ obstruction
Etiology
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Extrinsic Causes
Aberrant renal vessels, bands, adventitial tissues, and adhesions causing angulation or compression of UPJ
Intraluminal Causes
ureteral valves, benign fibroepithelial polyps
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Treatment
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Indications for Surgery:
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Clinical symptoms attributable to UPJO: pain, hypertension, or recurrent febrile urinary tract infections (UTI).
Surgical Approaches:
Conventional Pyeloplasty
Several techniques available, approached via lumbotomy, flank, or anterior extraperitoneal incision.
Flap Techniques: Includes Y-V-plasty, which uses renal pelvic tissue to augment the narrowed UPJ segment.
Dismembered Pyeloplasty (Anderson Hynes Pyeloplasty): Involves complete removal of the narrowed (dysfunctional) segment, tailoring of the renal pelvis if necessary, and re-approximation of the ureter to the renal pelvis in a dependent position.
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Follow-Up:
Follow-up ultrasound may be performed 3-6 months after the operation when maximum improvement can be seen.
Follow-up radionuclide scan should be done 6-8 months following pyeloplasty to evaluate an improvement in renal function and drainage.
Incidence
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More common in boys (2:1), two-thirds occur on the left side
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Radiological evaluation
Renal and Bladder US
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Features:
Dilated calyces depicted as multiple intercommunicating cystic spaces leading to a larger cystic structure at the hilum, representing the dilated renal pelvis.
Peripheral to the dilated calyces, the renal parenchyma is usually thinned with normal or increased echogenicity.
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CP
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Most infants asymptomatic, often detected through prenatal screening
follow up
Follow-up ultrasound may be performed 3-6 months after the operation when maximum improvement can be seen.
Follow-up radionuclide scan should be done 6-8 months following pyeloplasty to evaluate an improvement in renal function and drainage.