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Management of Upper Urinary Tract Obstruction
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=== Etiology === * '''<span style="color:#ff0000">Classified: congenital vs. acquired</span> or intrinsic vs. extrinsic''' * '''Most cases are congenital,''' but may only become clinically apparent much later in life **'''Congenital ureteropelvic junction obstruction (UPJO) usually results from intrinsic disease''' ***'''UPJO in neonates is most frequently found as a result of maternal-fetal ultrasound''' ****Many newborns diagnosed with hydronephrosis on are subsequently found to have UPJO * '''<span style="color:#ff0000">Congenital causes of UPJO (5):</span><span style="color:#0000ff"> SHAVA</span>''' *# '''<span style="color:#ff0000">True ureteral </span><span style="color:#0000ff">S</span><span style="color:#ff0000">tricture</span>''' *# '''<span style="color:#0000ff">H</span><span style="color:#ff0000">igh insertion</span> found more frequently in the presence of renal ectopia or fusion anomalies''' *# '''<span style="color:#0000ff">A</span><span style="color:#ff0000">berrant vessels</span> (controversy persists). Regardless, the presence of crossing vessels has a detrimental effect on the success rates of endopyelotomy''' *# '''<span style="color:#ff0000">Kinks or </span><span style="color:#0000ff">V</span><span style="color:#ff0000">alves</span>''' produced by infoldings of the ureteral mucosa and muscularis *# '''<span style="color:#0000ff">A</span><span style="color:#ff0000">peristaltic segment</span>''' * '''<span style="color:#ff0000">Acquired causes of UJPO (5):</span><span style="color:#0000ff"> CRIIBS</span>''' *# '''<span style="color:#0000ff">C</span><span style="color:#ff0000">ancer</span>''' *# '''<span style="color:#ff0000">Vesicoureteral </span><span style="color:#0000ff">R</span><span style="color:#ff0000">eflux</span><span style="color:#0000ff">;</span>''' can lead to upper tract dilation with subsequent elongation, tortuosity, and kinking of the ureter *# '''<span style="color:#ff0000">Post-</span><span style="color:#0000ff">I</span><span style="color:#ff0000">nflammatory or postoperative scarring or <span style="color:#0000ff">I</span><span style="color:#ff0000">schemia</span>''' *# '''<span style="color:#0000ff">B</span><span style="color:#ff0000">enign lesion (e.g. fibroepithelial polyps)</span>''' *# '''<span style="color:#0000ff">S</span><span style="color:#ff0000">tones</span>'''
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