The coexistence of obstruction at the ureteropelvic and ureterovesical junctions.

Obstructions at the ureteropelvic junction and ureterovesical junction were found to coexist in 14 children seen over an 11-year period. The coexistence of these two conditions made the diagnosis of each difficult. In only three children were both diagnoses made preoperatively; in the others, the second diagnosis was either suspected at surgery or was made on postoperative uroradiologic studies. Of five children in whom the initial diagnosis was obstruction at the ureteropelvic junction, only two have needed surgery for obstruction at the ureterovesical junction. Seven children had an initial diagnosis of obstruction at the ureterovesical junction, and all required subsequent pyeloplasty to relieve coexisting obstruction at the ureteropelvic junction. Therefore, our experience suggests that when both obstructions are known to exist or are suspected preoperatively, it is advisable to repair the stenosis at the ureteropelvic junction first, as distal ureteral surgery may not be necessary.