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Ureteropelvic Junction Obstruction
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Ureteropelvic junction (UPJ) obstruction
          • Synonyms

            • Pelviureteric obstruction
          • Definitions

            • 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 UTI, intermittent abdominal pain, vomiting, 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

                                        • Natural History & Prognosis

                                          • Treatment

                                            Selected References

                                            1. Senol C et al: Changes in Cajal cell density in ureteropelvic junction obstruction in children. J Pediatr Urol. 12(2):89.e1-5, 2016
                                            2. 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
                                            3. 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
                                            4. Parikh KR et al: Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels? Pediatr Radiol. 45(12):1788-95, 2015
                                            5. Cutroneo G et al: Altered cytoskeletal structure of smooth muscle cells in ureteropelvic junction obstruction. J Urol. 185(6):2314-9, 2011
                                            6. 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
                                            7. 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
                                            8. Wu Z et al: Novel method for double-J stenting in retroperitoneal laparoscopic dismembered pyeloplasty. Urology. 77(2):354-6, 2011
                                            9. 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
                                            10. Szavay PO et al: Functional outcome after laparoscopic dismembered pyeloplasty in children. J Pediatr Urol. 6(4):359-63, 2010
                                            11. Richstone L et al: Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology. 73(4):716-9; discussion 719, 2009
                                            12. 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
                                            13. 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
                                            14. 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
                                            15. Rooks VJ et al: Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol. 31(2):120-4, 2001
                                            16. Frauscher F et al: Crossing vessels at the ureteropelvic junction: detection with contrast-enhanced color Doppler imaging. Radiology. 210(3):727-31, 1999
                                            17. 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
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Ureteropelvic junction (UPJ) obstruction
                                                    • Synonyms

                                                      • Pelviureteric obstruction
                                                    • Definitions

                                                      • 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 UTI, intermittent abdominal pain, vomiting, 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

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      Selected References

                                                                                      1. Senol C et al: Changes in Cajal cell density in ureteropelvic junction obstruction in children. J Pediatr Urol. 12(2):89.e1-5, 2016
                                                                                      2. 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
                                                                                      3. 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
                                                                                      4. Parikh KR et al: Pediatric ureteropelvic junction obstruction: can magnetic resonance urography identify crossing vessels? Pediatr Radiol. 45(12):1788-95, 2015
                                                                                      5. Cutroneo G et al: Altered cytoskeletal structure of smooth muscle cells in ureteropelvic junction obstruction. J Urol. 185(6):2314-9, 2011
                                                                                      6. 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
                                                                                      7. 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
                                                                                      8. Wu Z et al: Novel method for double-J stenting in retroperitoneal laparoscopic dismembered pyeloplasty. Urology. 77(2):354-6, 2011
                                                                                      9. 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
                                                                                      10. Szavay PO et al: Functional outcome after laparoscopic dismembered pyeloplasty in children. J Pediatr Urol. 6(4):359-63, 2010
                                                                                      11. Richstone L et al: Pathologic findings in patients with ureteropelvic junction obstruction and crossing vessels. Urology. 73(4):716-9; discussion 719, 2009
                                                                                      12. 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
                                                                                      13. 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
                                                                                      14. 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
                                                                                      15. Rooks VJ et al: Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol. 31(2):120-4, 2001
                                                                                      16. Frauscher F et al: Crossing vessels at the ureteropelvic junction: detection with contrast-enhanced color Doppler imaging. Radiology. 210(3):727-31, 1999
                                                                                      17. 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