Obstruction at the Ureteropelvic Junction

Abstract

Although a variety of highly successful techniques for the repair of the obstructed ureteropelvic junction have now been firmly established, this frequent problem nevertheless continues to challenge our clinical skills. No firm criteria have been established to indicate just when a minimally obstructed renal pelvis should be repaired rather than simply observed; nor do we have adequate methods to predict when obstructive atrophy has progressed to the point that repair is futile and nephrectomy is required. These decisions are often made on the basis of the surgeon’s clinical impression—which will likely continue for some time—however, certain objective techniques are available which, combined with current knowledge of the pathophysiology of ureteropelvic junction obstruction, should allow more appropriate fitting of the operation to the patient.