Editing Management of Upper Urinary Tract Obstruction (section)

== Answers ==

# What are the causes of UPJO?
## Congenital '''SHAVA'''
### True ureteral '''S'''tricture
### '''H'''igh insertion; found more frequently in the presence of renal ectopia or fusion anomalies
### '''A'''berrant vessels (controversy persists). Regardless, the presence of crossing vessels has a detrimental effect on the success rates of endopyelotomy
### Kinks or '''V'''alves produced by infoldings of the ureteral mucosa and muscularis
### '''A'''peristaltic segment
## Acquired '''CRIBS'''
### Cancer
### Reflux
### Ischemia
### Benign tumour
### Stones
# What are the indications for intervention in UPJO?
## Symptoms
## Stones
## Renal insufficiency
## Infections
## Causal HTN
# What are the options for intervention in UPJO?
## Observation
## Diversion (stent or nephrostomy tube)
## Endoscopic (balloon dilation, endopyelotomy)
## Pyeloplasty
## Ureterocalycostomy
# How long is a stent kept for following pyeloplasty?
## 4-6 weeks
# When should a ureterocalycostomy be considered?
## Small renal pelvis
## Dependent drainage in malrotated/ectopic kidney
## Failed pyeloplasty
# What are the contraindications to endopyelotomy?
## Stricture > 2cm
## Active infection
## Uncontrolled coagulopathy
# Persistence of which structure results in a retrocaval ureter?
## Posterior cardinal vein
# What are the causes of ureteral stricture disease?
## Stones
## Instrumentation, endoscopic
## Infection (TB)
## Radiation
## Renal ablation injury
## Ischemia
## Idiopathic
## Periureteral fibrosis
# What are the management options for ureteral stricture disease?
## Diversion
## Endoscopic
## Surgical
### Ureteroureterostomy
### Ureteroneocystotomy
### Psoas hitch
### Boari flap
### Renal descensus
### Transureteroureterostomy
### Ileal ureter
### Autotransplant
# What are the contraindications to transureterostomy?
## Absolute: insufficient length of ureter
## Relative: history of stones, upper tract cancer, RPF, radiation, chronic pyelonephritis, any process that affects both ureters
# What investigations are needed before considering transureteroureterostomy?
## VCUG to rule out reflux
# What are the contraindications to ileal ureter substitution?
## Baseline renal insufficiency
## Bladder dysfunction or outlet obstruction
## Inflammatory bowel disease
## Radiation enteritis
# What is the preferred approach (retrograde vs. antegrade) for the endoscopic management of ureteroenteric stricture?
## Antegrade
# What are the risk factors for failure of endourological management of a ureteroenteric anastamostic stricture?
## Left sided stricture
## Stricture > 1cm