Congenital ureteropelvic junction obstruction: definition and therapy.

Congenital ureteropelvic junction (UPJ) obstruction is a well recognized pathology. It typically occurs due to the presence of an aperistaltic segment of the ureter, very frequently aggravated by a strangling vessel defined by different authors as "anomalous", "aberrant" or "crossing". An embryologic review of the development of the kidney, ureter and renal vessels reveals that such definitions are etiologically inadequate since such vessels almost always run anterior to the UPJ and therefore in reality are not anomalous or aberrant. It would be, therefore, more appropriate to speak of a "vascular bar" rather that congenital vascular anomaly. A series of 23 patients treated by a laparoscopic technique (15 using the Anderson-Hynes pyeloplasty, 4 Fenger's technique, 3 a simple ureterolysis, 1 necessitating a conversion to open procedure (due to bleeding) are presented. An inferior polar vessel was found in 15 cases and this was running anterior to the UPJ in 14. The mean operative time was 235 min., while the mean hospital stay 7 (3-15) days. The mean follow-up was 47.7 months. Twenty-one pts. (95.5%) were symptom-free with imaging studies confirming relief from obstruction.