Which of the following are causes of intrinsic primary UPJ obstruction?

Question: Which of the following are causes of intrinsic primary UPJ obstruction?
	1. Congenital malformation of the circular musculature of the ureter.
	2. Ureteral polyps.
	3. Crossing lower pole vessel.
	4. Stone disease.
	5. Severe vesicoureteral reflux that causes tortuosity and kinking of the ureter.

Answer:

The correct answers for the question "Which of the following are causes of intrinsic primary UPJ obstruction?" are:

1. Congenital malformation of the circular musculature of the ureter.

2. Ureteral polyps.

Explanation
Primary UPJ obstruction is further subdivided into intrinsic causes-including narrowing of the UPJ from disrupted development of circular musculature and extracellular matrix of the ureter, valvular mucosal folds, persistent fetal convolutions, and ureteral polyps-and extrinsic causes, particularly a crossing lower pole vessel. Secondary obstruction is most commonly caused by stone disease and also by severe vesicoureteral reflux causing tortuosity that leads to kinking of the ureter and subsequent obstruction.

From the manuscript:
Ureteral fibroepithelial polyp causing urinary obstruction
Radiology Case. 2012 Jul; 6(7):23-28

This article belongs to the GU section.

From the manuscript

Ureteral fibroepithelial polyp causing urinary obstruction

Free full text article: Ureteral fibroepithelial polyp causing urinary obstruction

Abstract
Ureteral polyps are rare causes of ureteropelvic junction (UPJ) obstruction, particularly in children. We report a nine year-old boy with UPJ obstruction initially suggestive of an obstructive urinary stone. CT showed intraureteral calcification at the UPJ and hydronephrosis. A retrograde pyelogram showed narrowing at the UPJ and partial obstruction that was found to be a ureteral polyp. This case illustrates a rare cause of UPJ obstruction that should be considered when the imaging findings and presentation are atypical for more common etiologies of ureteral obstruction.

1. Adey GS, Vargas SO, Retik AB, Borer JG, Mandell J, Hendren WH, Lebowitz RL, Bauer SB. Fibroepithelial polyps causing ureteropelvic junction obstruction in children. J Urol 2003 May;169(5):1834-6. PMID: 12686857

2. Niu ZB, Yang Y, Hou Y, Chen H, Wang CL. Ureteral polyps: an etiological factor of hydronephrosis in children that should not be ignored. Pediatr Surg Int 2007 Apr;23(4):323-6. PMID: 17377827

3. Lavelle JP, Knisely AS, Bellinger MF. Benign fibroepithelial polyps causing symptomatic bilateral intermittent hydroureteronephrosis. J Urol 1997 Aug;158(2):569. PMID: 9224362

4. Bartone FF, Johansson SL, Markin RJ, Imray TJ. Bilateral fibroepithelial polyps of ureter in a child. Urology 1990 Jun;35(6):519-22. PMID: 2353379

5. Romesburg JW, Stein RJ, Desai MM, Lagwinski N, Ross JH. Treatment of child with bilateral ureteropelvic junction obstruction due to fibroepithelial polyps and review of the literature. Urology 2009 Apr;73(4):929 e9-11. PMID: 18656248

6. Liddell RM, Weinberger E, Schofield DE, Pelman RS. Fibroepithelial polyp of the ureter in a child. AJR Am J Roentgenol 1991 Dec;157(6):1273-4. PMID: 1950880

7. Kojima Y, Lambert SM, Steixner BL, Laryngakis N, Casale P. Multiple metachronous fibroepithelial polyps in children. J Urol 2011 Mar;185(3):1053-7. PMID:21256525

8. Golda N, Kapoor A, DeMaria J. Laparoscopic pyeloplasty: role of preoperative retrograde pyelography. J Pediatr Urol 2008 Apr;4(2):162-4. PMID: 18631915

9. Cerwinka WH, Kirsch AJ. Urinary Tract Obstruction. Pediatric Urology. In: Palmer JS, editor: Humana Press; 2011. p. 269-85.
10. Rooks VJ, Lebowitz RL. Extrinsic ureteropelvic junction obstruction from a crossing renal vessel: demography and imaging. Pediatr Radiol 2001 Feb;31(2):120-4. PMID: 11214681

11. Fordham LA, Sutherland RW, Gipson DS. Imaging of Nephrolithiasis and Urinary Tract Calculi in Children. Evidence-Based Imaging in Pediatrics. In: Medina LS, Applegate KE, Blackmore CC, editors: Springer New York; 2010. p. 555-68.

12. Hwang AH, McAleer IM, Shapiro E, Miller OF, Krous HF, Kaplan GW. Congenital mid ureteral strictures. J Urol 2005 Nov;174(5):1999-2002. PMID: 16217377

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