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KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
- Pelviureteric obstruction
Definitions
- Ureteropelvic junction (UPJ) obstruction: Variable degree of blockage to urine flow at level of UPJ
- Most common urinary tract obstruction in pediatrics
- May be diagnosed antenatally with sonography or present in infancy or later childhood with urinary tract infection, intermittent abdominal pain, vomiting, &/or hematuria
- Occasionally found incidentally during trauma work-up
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
Fluoroscopic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Other Modality Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
- Houat AP et al: Congenital anomalies of the upper urinary tract: a comprehensive review. Radiographics. 41(2):462-86, 2021
- Expert Panel on Interventional Radiology et al: ACR Appropriateness Criteria® radiologic management of urinary tract obstruction. J Am Coll Radiol. 17(5S):S281-92, 2020
- Villanueva J et al: Point-of-care ultrasound is an accurate, time-saving, and cost-effective modality for post-operative imaging after pyeloplasty. J Pediatr Urol. 16(4):472.e1-6, 2020
- Bedoya MA et al: Relationship of renal apparent diffusion coefficient and functional MR urography in children with pelvicalyceal dilation. Pediatr Radiol. 49(8):1032-41, 2019
- Gnech M et al: Pyeloplasty vs. nephrectomy for ureteropelvic junction obstruction in poorly functioning kidneys (differential renal function < 20%): a multicentric study. J Pediatr Urol. 15(5):553.e1-3.e8, 2019
- Sertorio F et al: Non-contrast-enhanced magnetic resonance angiography for detecting crossing renal vessels in infants and young children: comparison with contrast-enhanced angiography and surgical findings. Pediatr Radiol. 49(1):105-13, 2019
- Wong MCY et al: Surgical validation of functional magnetic resonance urography in the study of ureteropelvic junction obstruction in a pediatric cohort. J Pediatr Urol. 15(2):168-75, 2019
- Carpenter CP et al: Hydronephrosis after pyeloplasty: "will it go away?" urology. 121:158-63, 2018
- Morin CE et al: Use of MR urography in pediatric patients. Curr Urol Rep. 19(11):93, 2018
- Wong MCY et al: Hydronephrosis and crossing vessels in children: optimization of diagnostic-therapeutic pathway and analysis of color Doppler ultrasound and magnetic resonance urography diagnostic accuracy. J Pediatr Urol. 14(1):68.e1-6, 2018
- Habibi HA et al: Acoustic radiation force impulse (ARFI) elastography in the evaluation of renal parenchymal stiffness in patients with ureteropelvic junction obstruction. J Med Ultrason (2001). 44(2):167-72, 2017
- Menon P et al: Outcome analysis of pediatric pyeloplasty in units with less than 20% differential renal function. J Pediatr Urol. 12(3):171.e1-7, 2016
- Senol C et al: Changes in Cajal cell density in ureteropelvic junction obstruction in children. J Pediatr Urol. 12(2):89.e1-5, 2016
- Brucher N et al: Non-contrast-enhanced MR angiography using time-spin labelling inversion pulse technique for detecting crossing renal vessels in children with symptomatic ureteropelvic junction obstruction: comparison with surgical findings. Eur Radiol. 26(8):2697-704, 2015
- Li R et al: Diagnosis and management of ureteral fibroepithelial polyps in children: a new treatment algorithm. J Pediatr Urol. 11(1):22.e1-6, 2015
- Menon P et al: Hydronephrosis: comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure. J Pediatr Urol. 11(2):80.e1-6, 2015
- Parikh KR et al: Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels? Pediatr Radiol. 45(12):1788-95, 2015
- Cutroneo G et al: Altered cytoskeletal structure of smooth muscle cells in ureteropelvic junction obstruction. J Urol. 185(6):2314-9, 2011
- Mei H et al: Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol. 25(5):727-36, 2011
- Samarasekera D et al: Endopyelotomy still has an important role in the management of ureteropelvic junction obstruction. Can Urol Assoc J. 5(2):134-6, 2011
- Wu Z et al: Novel method for double-J stenting in retroperitoneal laparoscopic dismembered pyeloplasty. Urology. 77(2):354-6, 2011
- Baek M et al: Long-term outcomes of dismembered pyeloplasty for midline-crossing giant hydronephrosis caused by ureteropelvic junction obstruction in children. Urology. 76(6):1463-7, 2010
- Szavay PO et al: Functional outcome after laparoscopic dismembered pyeloplasty in children. J Pediatr Urol. 6(4):359-63, 2010
- Richstone L et al: Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology. 73(4):716-9; discussion 719, 2009
- VanderBrink BA et al: Reconstructive surgery for lower pole ureteropelvic junction obstruction associated with incomplete ureteral duplication. J Pediatr Urol. 5(5):374-7, 2009
- Khaira HS et al: Helical computed tomography for identification of crossing vessels in ureteropelvic junction obstruction-comparison with operative findings. Urology. 62(1):35-9, 2003
- Brkljacic B et al: Doppler sonographic renal resistance index and resistance index ratio in children and adolescents with unilateral hydronephrosis. Eur Radiol. 12(11):2747-51, 2002
- Rooks VJ et al: Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol. 31(2):120-4, 2001
- Frauscher F et al: Crossing vessels at the ureteropelvic junction: detection with contrast-enhanced color Doppler imaging. Radiology. 210(3):727-31, 1999
- Amling CL et al: Renal ultrasound changes after pyeloplasty in children with ureteropelvic junction obstruction: long-term outcome in 47 renal units. J Urol. 156(6):2020-4, 1996
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
- Pelviureteric obstruction
Definitions
- Ureteropelvic junction (UPJ) obstruction: Variable degree of blockage to urine flow at level of UPJ
- Most common urinary tract obstruction in pediatrics
- May be diagnosed antenatally with sonography or present in infancy or later childhood with urinary tract infection, intermittent abdominal pain, vomiting, &/or hematuria
- Occasionally found incidentally during trauma work-up
IMAGING
General Features
Radiographic Findings
Ultrasonographic Findings
Fluoroscopic Findings
CT Findings
MR Findings
Nuclear Medicine Findings
Other Modality Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
Selected References
- Houat AP et al: Congenital anomalies of the upper urinary tract: a comprehensive review. Radiographics. 41(2):462-86, 2021
- Expert Panel on Interventional Radiology et al: ACR Appropriateness Criteria® radiologic management of urinary tract obstruction. J Am Coll Radiol. 17(5S):S281-92, 2020
- Villanueva J et al: Point-of-care ultrasound is an accurate, time-saving, and cost-effective modality for post-operative imaging after pyeloplasty. J Pediatr Urol. 16(4):472.e1-6, 2020
- Bedoya MA et al: Relationship of renal apparent diffusion coefficient and functional MR urography in children with pelvicalyceal dilation. Pediatr Radiol. 49(8):1032-41, 2019
- Gnech M et al: Pyeloplasty vs. nephrectomy for ureteropelvic junction obstruction in poorly functioning kidneys (differential renal function < 20%): a multicentric study. J Pediatr Urol. 15(5):553.e1-3.e8, 2019
- Sertorio F et al: Non-contrast-enhanced magnetic resonance angiography for detecting crossing renal vessels in infants and young children: comparison with contrast-enhanced angiography and surgical findings. Pediatr Radiol. 49(1):105-13, 2019
- Wong MCY et al: Surgical validation of functional magnetic resonance urography in the study of ureteropelvic junction obstruction in a pediatric cohort. J Pediatr Urol. 15(2):168-75, 2019
- Carpenter CP et al: Hydronephrosis after pyeloplasty: "will it go away?" urology. 121:158-63, 2018
- Morin CE et al: Use of MR urography in pediatric patients. Curr Urol Rep. 19(11):93, 2018
- Wong MCY et al: Hydronephrosis and crossing vessels in children: optimization of diagnostic-therapeutic pathway and analysis of color Doppler ultrasound and magnetic resonance urography diagnostic accuracy. J Pediatr Urol. 14(1):68.e1-6, 2018
- Habibi HA et al: Acoustic radiation force impulse (ARFI) elastography in the evaluation of renal parenchymal stiffness in patients with ureteropelvic junction obstruction. J Med Ultrason (2001). 44(2):167-72, 2017
- Menon P et al: Outcome analysis of pediatric pyeloplasty in units with less than 20% differential renal function. J Pediatr Urol. 12(3):171.e1-7, 2016
- Senol C et al: Changes in Cajal cell density in ureteropelvic junction obstruction in children. J Pediatr Urol. 12(2):89.e1-5, 2016
- Brucher N et al: Non-contrast-enhanced MR angiography using time-spin labelling inversion pulse technique for detecting crossing renal vessels in children with symptomatic ureteropelvic junction obstruction: comparison with surgical findings. Eur Radiol. 26(8):2697-704, 2015
- Li R et al: Diagnosis and management of ureteral fibroepithelial polyps in children: a new treatment algorithm. J Pediatr Urol. 11(1):22.e1-6, 2015
- Menon P et al: Hydronephrosis: comparison of extrinsic vessel versus intrinsic ureteropelvic junction obstruction groups and a plea against the vascular hitch procedure. J Pediatr Urol. 11(2):80.e1-6, 2015
- Parikh KR et al: Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels? Pediatr Radiol. 45(12):1788-95, 2015
- Cutroneo G et al: Altered cytoskeletal structure of smooth muscle cells in ureteropelvic junction obstruction. J Urol. 185(6):2314-9, 2011
- Mei H et al: Laparoscopic versus open pyeloplasty for ureteropelvic junction obstruction in children: a systematic review and meta-analysis. J Endourol. 25(5):727-36, 2011
- Samarasekera D et al: Endopyelotomy still has an important role in the management of ureteropelvic junction obstruction. Can Urol Assoc J. 5(2):134-6, 2011
- Wu Z et al: Novel method for double-J stenting in retroperitoneal laparoscopic dismembered pyeloplasty. Urology. 77(2):354-6, 2011
- Baek M et al: Long-term outcomes of dismembered pyeloplasty for midline-crossing giant hydronephrosis caused by ureteropelvic junction obstruction in children. Urology. 76(6):1463-7, 2010
- Szavay PO et al: Functional outcome after laparoscopic dismembered pyeloplasty in children. J Pediatr Urol. 6(4):359-63, 2010
- Richstone L et al: Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology. 73(4):716-9; discussion 719, 2009
- VanderBrink BA et al: Reconstructive surgery for lower pole ureteropelvic junction obstruction associated with incomplete ureteral duplication. J Pediatr Urol. 5(5):374-7, 2009
- Khaira HS et al: Helical computed tomography for identification of crossing vessels in ureteropelvic junction obstruction-comparison with operative findings. Urology. 62(1):35-9, 2003
- Brkljacic B et al: Doppler sonographic renal resistance index and resistance index ratio in children and adolescents with unilateral hydronephrosis. Eur Radiol. 12(11):2747-51, 2002
- Rooks VJ et al: Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol. 31(2):120-4, 2001
- Frauscher F et al: Crossing vessels at the ureteropelvic junction: detection with contrast-enhanced color Doppler imaging. Radiology. 210(3):727-31, 1999
- Amling CL et al: Renal ultrasound changes after pyeloplasty in children with ureteropelvic junction obstruction: long-term outcome in 47 renal units. J Urol. 156(6):2020-4, 1996
