BERKELEY, CA (UroToday Inc.) - Ureteropelvic junction (UPJ) obstruction can result from one of three entities: an intrinsic narrowing; a high insertion with or without and intrinsic narrowing; or an extrinsic compression such as a crossing lower pole vessel. Palmer et al described their initial experience using a renal pelvis cuff pyeloplasty technique to treat a high insertion UPJ obstruction without intrinsic narrowing.

They reviewed their experience regarding all children who underwent what they termed a renal pelvis cuff pyeloplasty. All patients had Society for Fetal Urology grade 3 to 4 hydronephrosis on ultrasonography and radiographic confirmation of UPJ obstruction by diuretic mercaptoacetyltriglycine renography. Pyeloplasty was performed through a flank incision. A circumferential incision was made of the renal pelvis proximal to the insertion site of the ureter into the renal pelvis. Next, a catheter was passed through the UPJ to ensure uniform patency. The cuff of pelvis with the attached ureter was then sutured to the dependent portion of the pelvis. Postoperative resolution of the obstruction was evaluated by ultrasonography and mercaptoacetyltriglycine renography.

They had a total of 11 children (6 boys and 5 girls) that underwent a renal cuff pyeloplasty .The median patient age was 6 months (range 2.5 months to 2.4 years) and median follow-up was 11 months (8 months to 3.4 years). All patients were discharged home within 2 days postoperatively. No intra-operative or postoperative complications were noted. All patients exhibited resolution of UPJ obstruction on follow-up radiography.

The group concluded that renal pelvis cuff pyeloplasty is a viable surgical option for UPJ obstruction resulting from a high inserting ureter without intrinsic ureteral obstruction. They claim that the procedure was straightforward with good results and without complications.

Journal of Urology. 174(3):1088-1090, September 2005