Tuesday, July 29, 2014

Historical Contribution: 1940, Jewett, UPJ Obstruction

1940

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.
In the patients with a crossing vessel, Dr. Jewett made the following observations (that still hold true today):
  • 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.
In the remaining 33 patients, the UPJ obstruction was caused by a combination of inflammation and infection (16).  Under the microscope, these patients had a thickened, fibrous stricture at the UPJ.

Importantly, Jewett also identified 17 patients in which there was no crossing vessel or inflammatory reaction. Through careful pathologic and histologic analysis, Jewett concluded these patients had a congenital UPJ obstruction.  

Drawing of a case of congenital stenosis of the ureteropelvic juncture without associated vessels.
Therefore, Dr. Jewett embarked on an autopsy analysis of 11 embryos, 50 stillborn children and 200 consecutive urograms.  He was able to determine the relative frequencies of UPJ obstruction and its etiologies:
  • Normal UPJ (85%)
  • UPJ Obstruction (15%)
    • Bands and kinks (5.6%)
    • Crossing renal vessel (33.8%)
    • Congenital Stenosis (60.5%)
In addition, from these studies he concluded: 
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.
Finally, he theorized a model by which hydronephrosis would develop from stenosis and was accelerated by crossing vessels, infection, high ureteral insertion and, possibly, rapid growth during puberty.  This model, developed 70 years ago, has changed very little in our most contemporary understanding of the UPJ obstruction.


To read the entire manuscript: follow the link above, visit the Centennial Website or click here.


HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 

5 comments:

  1. I would be very thankful if you continue with quality what you are serving right now with your blog. I really enjoyed it. and i really appreciate to you for this. Multi Speciality in Dombivali || Physician and Neurosurgeon in Dombivali || Multispeciality Hospitals in Dombivli

    ReplyDelete
  2. I like the valuable information you provide in your blog. I will bookmark your blog and check again here frequently. I'm quite certain I will learn many new stuff right here! Best of luck for the next! Cancer Surgeon in Dombivli || Urology Center in dombivli || Orthopedic Surgeon in Dombivli

    ReplyDelete
  3. i was just read your blog that was really superb got much pleasure to read that post. please keep sharing post like that.thanks for share with us for this post. Critical Care in Dombivali || Plastic Surgeon in dombivli || Orthopedic Hospital in Dombivli

    ReplyDelete
  4. Very informative and impressive post you have written, this is quite interesting and i have went through it completely, an upgraded information is shared, keep sharing such valuable information. Hospitals in Dombivli || Physiotherapy in Dombivli || Hospital in Dombivli

    ReplyDelete
  5. Thanks for sharing, nice post!

    ATS - địa chỉ bán vong ru tu dong cho be tại TP.HCM. Máy đưa võng hay võng tự động là sản phẩm tinh túy. Với sp may dua vong ts trở thành 1 phần của các gia đình với may dua vong nhưng bạn hãy cẩn thận với hàng giả với máy đưa võng giá rẻ hoặc siêu mắc. Bạn cần tham khảo giá máy đưa võng trước khi mua hay những meo giup be ngu ngon hq hay thực phẩm giúp bé ngủ ngon các mẹ cần biết, hay đeo kính áp tròng có tốt không các bạn nên biết!

    Đến với Bruno - thời trang H&M chính hãng uy tín tại TP.HCM là shop quần jean nam đẹp uy tín tại TP.HCM, đây là Bruno Store nơi cung cấp quần áo nam hàng hiệu chính hãng uy tín hay shop áo sơ mi nam tphcm uy tín hay shop Áo thun nam đẹp tphcm cho các bạn nam hay shop Áo khoác nam đẹp uy tín, chất lượng tại TP.HCM, hay quần Levis chính hãng hay những áo khoác da nam đẹp hay bạn có thể chọn cho mình mẫu thời trang thoi trang h & m cực sành điệu, hay bạn muốn mua quà sinh nhật cho chồng hay bạn muốn tặng quà sinh nhật cho bạn trai hay với câu hỏi mua áo sơ mi nam ở đâu hay mua quần jean nam ở đâu đẹp TPHCM và nơi đây bạn có thể mua quan ao qua mang uy tín tại TP.HCM.

    Những thực phẩm giúp đẹp da tại http://nhungthucphamgiupda.blogspot.com/
    Thực phẩm giúp bạn trẻ đẹp tại http://thucphamgiuptre.blogspot.com/
    Thực phẩm làm tăng tại http://thucphamlamtang.blogspot.com/
    Những thực phẩm giúp làm giảm tại http://thucphamlamgiam.blogspot.com/

    ReplyDelete