Lower pole pelvi‐ureteric junction obstruction in duplicated collecting systems

Authors from Philadelphia revisit their extensive experience in lower-pole PUJ obstruction in duplicated collecting systems, finding that this occurred in 2.05% of duplicated systems. They found an apparent increase in the incidence of this anomaly in boys, and in those with complete duplications. In the second paper in this section, authors from Belgrade describe calibration and dilatation with topical steroids in the treatment of stenosis of the neourethral meatus after hypospadias repair. OBJECTIVE To determine the incidence and efficacy of treatment for pelvi-ureteric junction obstruction (PUJO, the most common cause of hydronephrosis in the fetal kidney) in duplicated systems. PATIENTS AND METHODS We retrospectively assessed patients with PUJO in a duplex collecting system, reviewing each case for age, sex, anatomy, presenting symptoms and type of management. RESULTS From 1994 to 2004, 1413 patients were identified to have hydronephrosis; 243 of them had pyeloplasty for PUJO, and five (2%) involved the lower pole of a duplicated collecting system. In two of the patients the presentation was prenatal hydronephrosis (mean age at diagnosis 6 weeks) and the remainder presented with flank pain and pyelonephritis (mean age 5 years); all were boys. There was only one incomplete duplication (Y type). Four patients had a dismembered pyeloplasty and one a ureteric calycostomy. Vesico-ureteric reflux was present in three patients and two required common sheath reimplantation. On a radioisotope scan during the follow-up (mean 12 months) the five patients showed an improvement and no evidence of functional obstruction. CONCLUSION The incidence of PUJO in duplicated systems was 2%; treatment should be individualized and requires a careful preoperative evaluation. This anomaly appears to be more common in boys and in completely duplicated systems.