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Secondary Puj Obstruction
Secondary Puj Obstruction
Secondary Puj Obstruction
O B S TR U C TIO N
SECO N D ARY PU J
O BSTRU CTIO N
DEFINITION of PUJO
ETIOLOGY of PUJO
ASSESMENT of SECONDARY PUJO
MANAGEMENT OPTIONS
D EFIN ITIO N
Ureteropelvic junction (UPJ) obstruction is
defined as an obstruction of the flow of urine
from renal pelvis to the proximal ureter.
ETIO LO GY
Intrinsic obstruction due to scarring of
ureteral valves.
Ureteral hypoplasia resulting in abnormal
peristalsis through UPJ.
An abnormal or high insertion of ureter
into renal pelvis.
Crossing lower pole renal vessel(s)
Rotation of the kidney and renal
hypomobility causing intermittent
obstruction
ETIO LO GY
SECONDARY UPJ obstruction can be
M AN AG EM EN T O PTIO N S for
SECO N D ARY PU JO
ENDOPYELOTOMY
PYELOPLASTY
(open,laproscopic,robotic)
Complex reconstruction :
uretrocalycostomy
Autotransplastation +/- Boari flap
pelvivesicostomy
Long term ureteric stenting or PCN
Nephrectomy
Observation
op recovery.
Retrograde and Antegrade
approaches used.
Retrograde technique include wire
cutting ballon and ureteroscopic
laser pyelotomy with holmium or Nd
YAG laser.
Incision is made in the lateral aspect
of PUJ due to less chance of
Reconstructive options of
prim ary and secondary PU JO
generally utilized.
Increased morbidity with large
incision.
Robotic Pyeloplasty
Equivalent success rates to that of
N ephrectom y
Patients with poor renal function
CO N CLU SIO N S
Secondary PUJO is uncommon due to
CO N CLU SIO N S
Following endopyelotomy there is
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