Coexisting ureteropelvic junction obstruction and ureterovesical junction obstruction: Is pyeloplasty always the preferred initial surgery?

Yong Seung Lee, Young Jae Im, Hyeyoung Lee, Myung Joon Kim, MiJung Lee, Hyun Jin Jung, Sangwon Han

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Objective To report our experience with the diagnosis and management of coexisting ureteropelvic junction obstruction (UPJO) and ureterovesical junction obstruction (UVJO). Materials and Methods Among the pediatric patients who underwent pyeloplasty or ureteroneocystostomy from 2003-2012, 15 patients were diagnosed with coexisting UPJO and UVJO. We retrospectively analyzed their medical records. Results Of the 15 patients with coexisting UPJO and UVJO, the correct diagnosis was made preoperatively in 10 patients (66.7%). In 4 other patients, only UPJO was diagnosed, and in 1 patient, only UVJO was diagnosed. The decision of where to initially operate was determined from the combined results of the preoperative antegrade evaluation and retrograde ureteropyelography. Pyeloplasty was the initial surgical management choice for 9 patients, and ureteroneocystostomy was the initial surgical approach in 5 patients. In 1 patient, both pyeloplasty and ureteroneocystostomy were performed simultaneously. Of the 9 patients who underwent initial pyeloplasty, additional ureteroneocystostomy was required in 2. Additional pyeloplasty was required in 2 of the 5 patients who initially underwent ureteroneocystostomy. Conclusion It is often difficult to correctly diagnose coexisting UPJO and UVJO. In patients with UPJO, it is highly recommended that retrograde ureteropyelography be performed before pyeloplasty to evaluate the distal ureter-ureterovesical junction. Initial pyeloplasty is not always recommended as a first-line therapy.

Original languageEnglish
Pages (from-to)443-450
Number of pages8
Issue number2
Publication statusPublished - 2014 Jan 1


All Science Journal Classification (ASJC) codes

  • Urology

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