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Abstract

The traditional management of children with vesicoureteral reflux (VUR) and ureteropelvic junction obstruction (UPJO) is pyeloplasty as the initial step, and if the high-grade reflux remains symptomatic after pyeloplasty, surgical correction of the reflux is the next step. 1 Maizels M. Smith C.K. Firlit C.F. The management of children with vesicoureteral reflux and ureteropelvic junction obstruction. J Urol. 1984; 131: 722-727 PubMed Google Scholar It was postulated that the nearby obstruction to the renal parenchyma might cause more renal damage, so it should be managed sooner rather than later. Moreover, in a few pediatric urology centers, this concept has ultimately been changed by surgical correction of reflux (ureteral reimplantation) initially, followed by pyeloplasty in persistent UPJO. 1 Maizels M. Smith C.K. Firlit C.F. The management of children with vesicoureteral reflux and ureteropelvic junction obstruction. J Urol. 1984; 131: 722-727 PubMed Google Scholar However, we hypothesized that the secondary UPJ kinking could be eliminated gradually by endoscopic correction of reflux without compromising the distal ureteric neurovascular bundles and distal ureteral fibrosis during the ureteric reimplantation. Editorial CommentUrologyVol. 81Issue 5PreviewConcurrent vesicoureteral reflux (VUR) and ureteropelvic junction obstruction (UPJO) represent a potential diagnostic and therapeutic dilemma because it can sometimes be difficult to determine if the UPJO is primary or secondary to VUR. In some series, a pyeloplasty rate of 75% has been reported in children who present with simultaneous VUR and UPJO.1 The management algorithm used in the treatment of patients with simultaneous VUR and UPJO therefore carries with it significant therapeutic and costs implications, especially in this era of robotic-assisted ureteropelvic junction repair. Full-Text PDF