Extreme stone case and UPJ obstruction: Robotic management

Background: Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. To analyse the incidence of ureteropelvic junction (UPJ) obstruction in antenatally detected hydronephrosis cases.Methods: This prospective study was conducted February 2019 to August 2019 at the Institute of Child Health and Hospital for Children Egmore, Chennai. All the cases of hydronephrosis which were detected antenatally and those children presented with hydronephrosis in the neonatal period were taken for this study. Totally 58 cases were analyzed in the study, among that 32 cases detected antenatally with UPJ obstruction. Their epidemiology and their immediate postnatal findings (USG abdomen by 3-7 days, IVP and DTPA by 4-6 weeks) were recorded and the percentage of cases in which pelvic-ureteric junction obstruction was significant.Results: Among the cases that were diagnosed to have hydronephrosis antenatally (46), 69% (32/46) had UPJ obstruction, 21% (10/46) had bilateral hydronephrosis, 6.5% (3/46) had vesicoureteric reflux and rest had other anomalies (1/46).Conclusions: Antenatal hydronephrosis (ANH), one of the most common abnormal findings on the antenatal ultrasound (US), continues to increase as the standard of care includes the 2nd trimester US. US is the mainstay of the postnatal evaluation and voiding cystourethrogram may be safely reserved for high-grade ANH or dilated distal ureter. New urinary biomarkers may offer promising potential for more accurate risk stratification in the near future.

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Reverse Tubularized Pelvis Flap Method for the Treatment of Long Segment Ureteropelvic Junction Obstruction

Medical Principles and Practice ◽

10.1159/000502028 ◽

2019 ◽

Vol 29 (2) ◽

pp. 128-133 ◽

Cited By ~ 1

Author(s):

Haluk Sarihan ◽

Hatice Sonay Yalçın Comert ◽

Mustafa İmamoğlu ◽

Dilek Basar

Keyword(s):

Blood Supply ◽

Ureteropelvic Junction Obstruction ◽

Good Health ◽

Distal Portion ◽

Ureteropelvic Junction ◽

Absorbable Suture ◽

Distal Ureter ◽

Upj Obstruction ◽

Age Range

Objective: The most common cause of urinary obstruction is ureteropelvic junction (UPJ) obstruction. In short stenosis, a dismembered pyeloplasty is performed, but for long segment stenosis, the procedure is not well defined. We present the reverse flap ureteroplasty method, which we prepared from the pelvis for use in long segment UPJ obstruction. Methods: Between 2007 and 2016, we operated on 6 cases (4 males, 2 females) with an age range of 2–6 months. After reaching the UPJ region, depending on the length of the long segment obstruction, a flap measuring 25–35 mm in length was prepared from the pelvis so that its width would be 10–12 mm on the pelvis side and 10 mm in the distal portion. It was then reversed and tubularized with an absorbable suture over a 10-French nelaton catheter. The end of this ureter and the end of the distal ureter were spatulated and anastomosed. A double J and minivac drain were used in each case. Results: There were no complications in the postoperative period of all our patients. They were all discharged with good health. Follow-up with renal ultrasonography showed that the anteroposterior diameters were decreased and that parenchymal thicknesses had returned to normal. Secondary stenosis, flap necrosis, and retraction did not develop. Conclusion: Because the blood supply of the pelvis is increased in patients with UPJ obstruction, a reverse flap of adequate length with preserved blood supply can be achieved and tubularized. We suggest that this method will be appropriate for the treatment of long segment UPJ obstruction.

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503 The ultrasonographic evolution of the hydronephrosis and renal parenchyma thickness in patients with congenital ureteropelvic junction (UPJ) obstruction who underwent pyeloplasty

European Urology Supplements ◽

10.1016/s1569-9056(12)60500-4 ◽

2012 ◽

Vol 11 (1) ◽

pp. e503-e503a

Author(s):

Y.A. Ferreira ◽

E.M. Araújo ◽

J.P.M. Ribeiro-Neto ◽

J.G.B. Alves ◽

L.F. Nóbrega ◽

...

Keyword(s):

Renal Parenchyma ◽

Ureteropelvic Junction ◽

Upj Obstruction

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Giant fibroepithelial polyp of the ureter

BMJ Case Reports ◽

10.1136/bcr-2016-218999 ◽

2017 ◽

pp. bcr-2016-218999 ◽

Cited By ~ 1

Author(s):

Mayank Gupta ◽

Sanjeet Roy ◽

Cornerstone Wann ◽

Anu Eapen

Keyword(s):

Urothelial Carcinoma ◽

Rare Case ◽

Histopathological Examination ◽

Frozen Section ◽

Polypoid Lesion ◽

Ureteropelvic Junction ◽

Fibroepithelial Polyp ◽

Upj Obstruction

Giant fibroepithelial polyp is a rare cause of ureteric/ureteropelvic junction (UPJ) obstruction. We report a rare case of giant fibroepithelial polyp in a 32-year-old woman involving the whole length of the ureter, reaching up to the UPJ which was clinically and radiologically considered to be urothelial carcinoma. Frozen section showed a polypoid lesion lined by urothelium with no evidence of dysplasia or malignancy. Subsequently, nephroureterectomy was done as there was marked renal hydronephrosis and it was impossible to separate the polyp from the wall of the ureter. Histopathological examination and immunohistochemistry confirmed the diagnosis of giant fibroepithelial polyp, ruling out malignancy.

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