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The first 25 slides, exactly as they appear. The full deck has 72 content slides.
Paediatric Surgery
Ureteropelvic Junction Obstruction
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
9 sections · 72 slides
Overview
- What this deck will teach you
The Problem
What UPJO is and why it matters
- First, the anatomy in plain terms
- What 'obstruction' actually means here
- Why this became a huge topic
- UPJO by the numbers
- UPJO is the headline cause of antenatal hydronephrosis
- What else can swell a fetal kidney
Why It Happens
The three mechanisms and the genetics
- Three ways a UPJ can obstruct
- Intrinsic obstruction: the failed squeeze
- What is wrong in the junction wall
- Extrinsic and secondary obstruction
- The genetics: mostly complex, occasionally single-gene
- What does CAKUT mean, and why mention it here?
Finding It Before Birth
Prenatal detection and grading
- What the fetal scan can see, and when
- Measuring the swelling: anteroposterior diameter (APD)
- Grading antenatal hydronephrosis by pelvis width (APD)
- The Society for Fetal Urology (SFU) grade
- Chance the swelling settles on its own, by SFU grade
- SFU ultrasound grading scale in detail
- A shared language: the UTD system
- The UTD risk buckets
- How UTD risk drives the follow-up plan
- Fetal MRI: a problem-solver, not a routine test
- Prenatal intervention: rarely, and only in expert hands
The Diagnostic Work-up
After birth: which test answers which question
- The clinical picture, then and now
- The central diagnostic dilemma
- Left UPJ obstruction across four imaging tests
- Ultrasound: the first and repeatable test
- Why must a newborn boy with bilateral antenatal hydronephrosis be scanned within 24 hours?
- Isotope renography: function and drainage
- Why newborn isotope scans are tricky
- The supporting cast of tests
- The Whitaker pressure-flow test: the tie-breaker
- VCUG: looking for coexisting reflux
Watch or Operate?
The management decision
- The great management debate
- What the long follow-up studies showed
- The current decision rule
- A simplified UPJO management pathway
- Thresholds that push toward pyeloplasty
Surgical Repair
Pyeloplasty and its variants
- What a pyeloplasty is trying to achieve
- The open surgical approach
- Positioning and opening for open pyeloplasty
- Posterior lumbotomy: a smaller back approach
- Two families of pyeloplasty
The Pyeloplasty Techniques
Dismembered, flap, endoscopic, minimal-access
- Anderson-Hynes pyeloplasty: the gold standard
- Steps of the Anderson-Hynes dismembered pyeloplasty
- Stenting choices in dismembered repair
- Non-dismembered flap repairs
- The Culp spiral-flap pyeloplasty
- Endoscopic options: endopyelotomy
- Balloon dilatation
- Laparoscopic pyeloplasty
- Robotic pyeloplasty (RALP)
- Kidney preservation decisions
After Surgery
Complications, follow-up and results
- Postoperative complications
- Follow-up and long-term results
- The essentials to remember
- References (1/5)
- References (2/5)
- References (3/5)
- References (4/5)
- References (5/5)
- Pediatric Surgery and Pediatric Urology