Ureterocalicostomy for Treatment of Complex Cases of Ureteropelvic Junction Obstruction in Adults

Objectives: To evaluate ureterocalicostomy (UC) in the management of selected cases of ureteropelvic junction (UPJ) obstruction.

Methods: The data from 22 patients who underwent UC from April 2002 to April 2009 were reviewed. The indications for UC were primary UPJ obstruction with completely intrarenal pelves (2 cases), complicated (secondary or recurrent) UPJ obstruction with an intrarenal pelvis and/or reversed caliceopelvic ratio (16 cases) and after iatrogenic injury at the UPJ (4 cases). The evaluation of treatment outcome was performed subjectively by symptom assessment and objectively using ultrasonography, radiography, and radioisotope diuretic renography.

Results: After a mean follow-up of 26.7±20.99 months, UC success was achieved in 16 patients (73%), with complete cure in 12 and improvement in 4. In 2, the condition remained stable, and failure occurred in 4 patients. Of these 4 patients, 2 underwent nephrectomy and 2 were treated with indwelling double-J stents with frequent exchanges.

Conclusions: The results of UC in the present study were satisfactory. The procedure could be the best alternative in the case of complex UPJ obstruction in the presence of intrarenal pelvis and/or when the degree of calicectasis is greater than that of pyelectasis.