Ureteropelvic Junction Obstruction

Abstract

Ureteropelvic junction obstruction (UPJO) is defined as a functional impairment of urine flow from the renal pelvis to the ureter. Whatever the cause, UPJO warrants prompt attention to alleviate symptoms and to prevent deterioration of renal function, development of stones, urinary tract infection, and, albeit rarely, hypertension. When intervention is indicated, open dismembered pyeloplasty has historically been the gold standard. However, with the advancements in endourological instrumentation, the direction has shifted toward minimally invasive procedures such as endopyelotomy (antegrade and retrograde), laparoscopic pyeloplasty, and robotic pyeloplasty. Adherence to strict endourological principles and direct visualization make retrograde ureteroscopic endopyelotomy a safe and effective treatment option for patients with UPJO. The ureteroscopic approach has a short learning curve, and can be performed in almost all general hospitals where ureteroscopy is performed. As ureteroscopic instruments are evolving, the trend will continue to favor minimally invasive techniques, and retrograde ureteroscopic endopyelotomy will remain a significant treatment option in the management of well-selected patients with UPJO.