Possible etiologies for UPJ obstruction include the following: Intrinsic obstruction may result from stenosis due

due to scarring of ureteral valves. Ureteral hypoplasia may result in abnormal peristalsis through the UPJ. Asymmetry of ureteral wall musculature may inhibit the natural peristaltic emptying of the renal pelvis into the ureter. An abnormal or high insertion of the ureter into the renal pelvis may alter the configuration and impair drainage of urine. This may be an effect rather than a cause because the two etiologies mentioned above may manifest as a high-insertion variant seen on imaging studies. Crossing lower-pole renal vessel(s) or entrapment of the ureter by a vessel can prohibit urinary flow down the ureter. Vessels that wrap around the UPJ may be associated with obstruction or may be a product of renal dilatation and hydronephrosis that distorts renal vascular architecture. Rotation of the kidney (eg, renal ectopy) and renal hypermobility can cause intermittent obstruction that is solely dependent on the position of the kidney relative to the ureter. This was once a very popular diagnosis; however, the other etiologies mentioned above are more prevalent today, and this cause is particularly rare. Secondary UPJ obstruction can be caused by prior surgical intervention to treat other disorders (eg, renal stone disease) or failed repair of a primary UPJ obstruction. This obstructive lesion is usually secondary to ureteral-wall and periureteral scar formation. UPJ obstruction manifests bilaterally in 10% cases.