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Role of Endoluminal Sonography in Evaluation of Obstruction of the Ureteropelvic Junction

Ling Lin1, Demetrius H. Bagley2 and Ji-Bin Liu3

1 Department of Ultrasound, Huaxi Hospital of Sichuan University, Sichuan, China.
2 Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA.
3 Department of Radiology, Thomas Jefferson University Hospital, 7th Fl. Main Bldg., 132 S. 10th St., Philadelphia, PA 19107.


Figure 1
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  		Fig. 1 —45-year-old woman with simple ureteropelvic junction obstruction. Endoluminal 3D image shows cross-sectional (CS), longitudinal (L), and coronal (C) views of ureteropelvic junction with no evidence of abnormality. RP = renal pelvis, UT = ureter, P = probe.

 

Figure 2
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  		Fig. 2 —48-year-old man with ureteropelvic junction obstruction with crossing vessels and septum. Longitudinal and coronal 3D image shows ureteral septum (S) and crossing vessels (V) in ureteropelvic junction. Spatial relations of structures were easily and fully appreciated. P = probe, RP = renal pelvis.

 

Figure 3
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  		Fig. 3 —59-year-old man with ureteropelvic junction obstruction with narrow ureteral segment. Longitudinal 3D image of proximal ureter shows evidence of narrow ureteral segment with echogenic area (arrows) representing fibroconnective tissue. U = ureter.

 

Figure 4
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  		Fig. 4A —59-year-old man with obstructing proximal ureteral–ureteropelvic junction calculi. Reconstructed multiplanar image shows submucosal calculi (arrows) and vessels (V) at ureteropelvic junction. P = probe.

 

Figure 5
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  		Fig. 4B —59-year-old man with obstructing proximal ureteral–ureteropelvic junction calculi. Three-dimensional longitudinal image shows multiple small fragments (F) of calculi. P = probe, RP = renal pelvis.

 

Figure 6
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  		Fig. 5 —44-year-old woman with bifid renal pelvis (RP). Three-dimensional image shows septum (arrows) dividing pelvis into two portions. Length and thickness of septum are evident. Sonographic finding is consistent with diagnosis of bifid pelvis.

 

Figure 7
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  		Fig. 6A —37-year-old man with ureteropelvic junction obstruction with crossing vessel and adjacent small bowel. Two-dimensional image of proximal ureter shows small bowel (SB) anterior to ureter and crossing vessel (not shown).

 

Figure 8
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  		Fig. 6B —37-year-old man with ureteropelvic junction obstruction with crossing vessel and adjacent small bowel. Reconstructed longitudinal view of ureteropelvic junction clearly shows crossing vessel (V) and small bowel (SB) and their relations to each other. RP = renal pelvis.

 

Figure 9
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  		Fig. 7A —58-year-old man with obstructing neoplasm at ureteropelvic junction. Two-dimensional cross-sectional image shows hypoechoic tumor (T) at region of ureteropelvic junction. P = probe, RP = renal pelvis.

 

Figure 10
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  		Fig. 7B —58-year-old man with obstructing neoplasm at ureteropelvic junction. Three-dimensional reconstruction shows overall size and extent of tumor. Distribution of tumor (T) and its relation to ureteropelvic junction can be depicted only on 3D rendering. P = probe, RP = renal pelvis.

 

Figure 11
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  		Fig. 8A —65-year-old woman with ureteropelvic junction obstruction with crossing vessels and septum. Three-dimensional image obtained before endopyelotomy of obstructed ureteropelvic junction shows septum (arrows) within renal pelvis and two crossing vessels (V) in anterior aspect of longitudinal view.

 

Figure 12
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  		Fig. 8B —65-year-old woman with ureteropelvic junction obstruction with crossing vessels and septum. Three-dimensional image shows septum was successfully removed with endopyelotomy. This information was useful for precise removal of septum to avoid damage to adjacent vessels (V).

 

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