Renal pelvis cuff pyeloplasty for ureteropelvic junction obstruction for the high inserting ureter: an initial experience.

PURPOSE: Ureteropelvic junction (UPJ) obstruction can result from a high inserting ureter without intrinsic ureteral obstruction. We describe our initial experience using a renal pelvis cuff pyeloplasty technique to treat this cause of UPJ obstruction.

MATERIALS AND METHODS: We reviewed our experience regarding all children who underwent 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.

RESULTS: A total of 11 children (6 boys and 5 girls) underwent renal cuff pyeloplasty for UPJ obstruction due to a high inserting ureter. Median patient age was 6 months (range 2.5 months to 2.4 years) and median followup was 11 months (8 months to 3.4 years). All patients were discharged home within 2 days postoperatively. No intraoperative or postoperative complications were noted. All patients exhibited resolution of UPJ obstruction on followup radiographs.

CONCLUSIONS: Renal pelvis cuff pyeloplasty is a surgical technique for UPJ obstruction resulting from a high inserting ureter without intrinsic ureteral obstruction. The procedure was straightforward with good results and without complications in this initial experience.