Forming a stone in pelviureteric junction obstruction: Cause or effect?

Abstract

Objectives: To investigate a possible causal relationship for stone formation in pelviuretericjunction obstruction and to outline management options. Materials and Methods: A literature search and evidence synthesis was conducted viaelectronic databases in the English language using the key words pelviureteric junctionobstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy percutaneous nephrolithotomy, alone or in combination. Relevant articles wereanalysed to extract conclusions. Results: Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasishas been reported only scarcely in the literature. Although PUJO has been extensivelystudied throughout the years, the presence of calculi in such a patient has notreceived equal attention and there is still doubt surrounding the pathophysiologyand global management. Conclusions: Metabolic risk factors appear to play an important role, enough to justifymetabolic evaluation in these patients. Urinary stasis and infection are well knownfactors predisposing to lithiasis and contribute to some extent. The choice for treatmentis not always straightforward. Management should be tailored according to degreeof obstruction, renal function, patient symptoms and stone size. Simultaneoustreatment is feasible with the aid of minimally invasive operative techniques and laparoscopyin particular.