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The first 25 slides, exactly as they appear. The full deck has 59 content slides.
Paediatric Surgery
Ureterovesical Junction Obstruction
Built from Puri — Pediatric Surgery and Pediatric Urology
What’s inside
7 sections · 59 slides
Overview
- What this topic covers
Foundations
What the obstruction is and why it harms the kidney
- What is ureterovesical junction obstruction?
- How common is it?
- Why a blocked ureter is dangerous
- Dilated renal pelvis and tortuous ureter on MRI
Definition and Classification
Naming and sorting the megaureter
- Defining the megaureter
- Smith classification (1977, modified by King 1980)
- Pfister-Hendren classification (1971 / 1978)
Pathophysiology
Why the urine bolus stops moving
- What actually causes the block?
- Aperistaltic juxtavesical ureteral segment
- A self-worsening cycle
Diagnosis
Spotting the obstruction and judging its severity
- The core diagnostic challenge
- Antenatal ultrasound: the first look
- Antenatal ultrasound of a dilated kidney and ureter
- Grading prenatal dilatation
- Society for Fetal Urology renal pelvis grading
- Postnatal ultrasound: timing matters
- Postnatal ultrasound of bladder and dilated ureter
- Ruling out the mimics: voiding cystourethrogram
- Diuretic renography: measuring the drainage
- How the diuretic MAG3 scan is run
- Diuretic MAG3 renography in hydroureteronephrosis
- What the MAG3 scan reports
Management
From reassurance and antibiotics to reconstruction
- Prenatal management and counselling
- Antibiotic prophylaxis at birth
- Expectant management: watchful waiting
- When and why to operate
- Temporizing options: buying time in tiny babies
- Temporizing without a stoma
- Endourology: three keyhole approaches
- Double J stenting
- High-pressure balloon dilatation (HPBD)
- Cutting balloon endoureterotomy (CBU)
- Cutting balloon endoureterotomy
- Retrograde study of an obstructed ureter
- After the dilatation
- Ureteral reimplantation: the fallback repair
- The Cohen cross-trigonal technique
- Cohen cross-trigonal ureteric reimplantation
- The 5:1 rule and ureteral tapering
- Minimally invasive and robotic reimplantation
- Robotic extravesical ureteral reimplantation
- Weighing the minimally invasive route
Bringing it together
Key messages and self-test
- Three things to remember
- Summary
- On a diuretic MAG3 scan, what distinguishes true obstruction from merely slow drainage?
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- Pediatric Surgery and Pediatric Urology