Nephro-Urol Mon. 2017 September; 9(5):e57201. Published online 2017 September 7. doi: 10.5812/numonthly.57201. Research Article The Dilemma of Ureterovesical Junction Obstruction Seyed Mohammadreza Rabani, 1,* and Ali Mousavizadeh 2 1 Associate Professor of Urology and Renal Transplantation, Beheshti Teaching Hospital, Yasuj University of Medical Sciences, Yusuj, Iran 2 Assistant Professor of Epidemiology, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yusuj, Iran * Corresponding author: Seyed Mohammadreza Rabani, Associate Professor of Urology and Renal Transplantation, Beheshti Teaching Hospital, Yasuj University of Medical Sciences, Yusuj, Iran. Tel: +98-9177411389, E-mail: smrrabani@yahoo.com Received 2017 April 17; Revised 2017 July 01; Accepted 2017 August 20. Abstract Background: Ureterovesical junction obstruction (UVJO) is the result of an anatomic or a functional abnormality in the distal seg- ment of the ureter. There are many types of UVJO, different in their cause, presentation, imaging characters, and prognosis. Objectives: The aim of this study was to discuss the postoperative natural course and prognosis of patients undergoing standard approaches on the management of primary UVJO by one surgeon in a 10-year period starting from 2004. Methods: From January 2004 to October 2013, 64 patients who underwent ureteral tapering and stenting ureteroneocystostomy for complicated primary UVJO participated in the study. Results: The mean age of patients was 26 years (range: 11 months to 73 years). The mean hospital stay was 5 days (range: 4 to 7 days). The post-operative time was between 1 and 2 hours. Double J stent was left in place for 4 weeks. Post-operative follow-up was at least one year. No major complication was encountered, instead, a decrease in symptoms in all patients and an increase in renal function in 40 out of 64 (62.5%) patients were observed in the one-year follow-up of the diethylenetriaminepentaacetic acid (DTPA) renal scanning. Only 3 patients had fever as a postoperative minor complication. Conclusions: Decision making in the treatment of UVJO is somewhat a dilemma. This condition is occasionally asymptomatic and uneventful, and may be detected accidentally during an unrelated work-up; nonetheless, it may also cause serious life threatening complications. Surgical management in complicated cases may be a safe and viable treatment option both in children and in adults. Keywords: Congenital Abnormalities, Ureteral Obstruction, Hydroureteronephrosis 1. Background UVJO is the result of an anatomic or a functional ab- normality in the distal portion of the ureters. Gil Vernet described the normal anatomy of the ureterovesical junc- tion, and explained 3 distinguished segments at this part of the ureter: juxta-vesical, intramural, and sub mucosal segments, associated by Waldeyer’s sheath and pre-vesical sphincter (1). After ureteropelvic junction obstruction (UPJO), UVJO is the second most common cause of hydro- nephrosis in newborns, accounting for approximately 20% of cases, with an estimated incidence of 36 per 100000 live births (2). There are many types of UVJOs, with differ- ent causes, presentations, imaging characters, and prog- nosis. Decision making in this condition also depends on the types of UVJO and its related characteristics. Al- though the true pathogenesis of primary UVJO is uncer- tain, it appears that it is usually a result of an abnormal- ity or delay in the development of muscles in the distal fetal ureter at 20th week of gestation. Historically, differ- ent types of open surgery including anti-refluxing or sim- ple ureteral re-implantation with or without ureteral ta- pering, laparoscopic or robotic surgery, and endoscopic management have been used for the treatment of primary UVJO. Nephrectomy may be rarely suggested in symp- tomatic patients with a nonfunctional kidney. Decision making in the treatment of UVJO is somewhat a dilemma. This condition is occasionally asymptomatic and uneventful and may be detected accidentally during an unrelated work up, but it may also cause serious life threatening complications. There are controversies on the approach toward primary UVJO cases in clinical practices, especially in patients that refer to a clinic by flank pain without any serious complicated event. While a number of experts consider conservative approaches in dealing with the asymptomatic disease, some experts prefer surgery. The main claim of conservative expert opinions is insuffi- ciency of surgery, and postoperative complications for the patient. There are many types of complications occurring after UVJO operation. An important role of the physician is to conduct a good and long-term follow-up for these pa- tients after treatment. Complications such as urinary extravasation, collec- tion, infection, and ureteral stricture may be encountered. The follow-up and reporting of probable complications in long term is not only a task for physician to ensure about the efficacy of intervention and satisfaction of patients, but also important to evaluate and compare methods used by Copyright © 2017, Nephro-Urology Monthly. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.