H. J. Jewett. Stenosis of the ureteropelvic juncture - Congenital and acquired. Journal of Urology, 1940 44: 247-258.
Ureteropelvic junction (UPJ) obstruction is a partial or total blockage at the place where the kidney and the ureter are joined. UPJ obstruction is more common in children than in adults and often resulting from a congenital abnormality and is the most common cause of hydronephrosis (swelling of the renal pelvis, where urine collects from the kidney) detected on prenatal ultrasound or in newborns. UPJ obstruction impedes the flow of urine, causing it to build up and resulting in hydronephrosis and has the potential complications of recurrent infection and kidney damage.
In this manuscript from 1940, Dr. Jewett reviews the cases of 71 patients with hydronephrosis and a UPJ obstruction. Dr. Jewett found that 4 patients had stricture, 24 had a crossing vessel causing obstruction and the remaining 43 patients had an obstruction of unclear etiology. In classifying these patients, in whom the etiology of the obstruction was unclear, Jewett found that a crossing vessel was the culprit in 10.
|Drawing of a case of congenital stenosis of the ureteropelvic juncture associated with accessory renal vessel.|
- UPJ obstruction without a crossing vessel is 3x more common than with a crossing vessel
- The average age of onset in this cohort is younger (13 versus 24 years-old)
- A crossing vessel is not always associated with UPJ obstruction (24 cases)
- UPJ obstruction with a crossing vessel is characterized by a delicate and thin proximal ureter, as opposed to obstruction cases by trauma or inflammation.
|Drawing of a case of congenital stenosis of the ureteropelvic juncture without associated vessels.|
- Normal UPJ (85%)
- UPJ Obstruction (15%)
- Bands and kinks (5.6%)
- Crossing renal vessel (33.8%)
- Congenital Stenosis (60.5%)
It is possible, therefore, that a ureteropelvic juncture represents a minimal narrowing which, when present in marked degree, becomes a congenital stenosis.
In the group of cases comprising inflammatory strictures, it is impossible to determine with any degree of certainty whether the inflammatory reaction was primary or whether it was superimposed upon a simple congenital stenosis.