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Ureteropelvic Junction Obstruction

A ureteropelvic junction obstruction refers to a blockage of urine transfer which is caused when the renal pelvis and ureter are blocked. This is most often seen in children and needs immediate and expert medical care for effective treatment.

Normally, kidneys produce urine as they filter the blood and remove waste products, salt and water from it. The urine is then passed out of the kidneys to the urinary system. There is a funnel-shaped structure called the renal pelvis which collects the urine from the kidney before passing it on to the ureter (tube-like structure for passing out urine from the body). For the kidneys to function normally there has to be at least one perfectly working ureter in each kidney for efficiently carrying the urine from the kidney to the bladder.

Let us understand some important points about ureteropelvic junction obstruction.

What is ureteropelvic junction (UPJ) obstruction?

Ureteropelvic junction (UPJ) obstruction is commonly caused in children as a congenital development (birth defect). The obstruction occurs at the point where the renal pelvis meets the ureter – called the Ureteropelvic junction (or UPJ). Although this is a considerably rare condition, it causes development of obstruction in the urine system in the prenatal stage.

As a result of UPJ, the kidney tends to produce excessive amounts of urine, which is enable to efficiently drain out of the renal pelvis and into the ureter. This causes the excess urine to get collected in the kidney (called ‘hydronephrosis’) and lead to other complications.

What are the symptoms of ureteropelvic junction (UPJ) obstruction? 

As UPJ (ureteropelvic junction) obstruction is a prenatal condition mainly, it is difficult to observe visible symptoms. Hence, ultrasound is the best option to check and diagnose for UPJ obstruction before child birth.

In other cases, these are the symptoms that are usually seen as a result of UPJ obstruction:

  • Abdominal mass

  • Urinary infection accompanied with fever

  • Pain in flanks when fluid intake in increased

  • Kidney stones

  • Blood in urine

  • Pain without infection

  • Sporadic bouts of pain

How is ureteropelvic junction (UPJ) obstruction diagnosed?

UPJ obstruction is diagnosed only when performing a regular ultrasound checkup of the fetus or when specifically looking for the symptoms of the condition.

Although ultrasound testing is efficient in recognizing the signs of UPJ obstruction in pre-natal stage it becomes necessary to perform one or more functional tests to gauge the ability of the kidney for producing and passing out the urine.

Ideally, UPJ obstruction is diagnosed using the advanced IVP (intravenous Pyelogram) test. In this, the doctor will inject a sterile dye into the bloodstream. As the dyed blood passes through the kidney it performs its cleaning function and the remaining amount of dye in the urine passed out of the body helps to determine the level of functionality in the kidney. Using an advanced x-ray imaging system, the doctor is able to see clearly the shape of the kidney, renal pelvis and the ureter.

How is ureteropelvic junction (UPJ) obstruction treated?

Although many cases of initial urine blockage begin to show improvement without apparent treatment it is advisable to consult a renowned pediatric urologist to determine whether treatment for UPJ obstruction is required in the case. Such improvements are seen mostly within the first 18 months of the infant’s life. In case the condition worsens and the doctor so advises, the child might need surgical treatment.

Commonly, a conventional (open) surgery called pyeloplasty is used to remove the obstruction in the UPJ and then re-attach the ureter to the pelvis which helps to divert the flow of urine to a clear channel. This surgical treatment helps to reinstate the normal production and drainage of urine from the kidney through the ureter. This helps to relieve painful symptoms caused by the condition.

Advanced treatment methods for UPJ obstruction involve minimally invasive surgical methods. The doctor might choose to perform a laparoscopic pyeloplasty or an internal incision of the UPJ altogether.

What can be expected after treatment for ureteropelvic junction (UPJ) obstruction?

After a treatment for UPJ obstruction, usually swelling is seen in the ureter and the kidney might not drain the urine completely initially. This improves significantly as the incisions heal. A drainage tube may be placed in the beginning of the recuperating period to help the kidney drain urine better while it heals.

Frequently asked questions:

What did I do during pregnancy to cause this problem in my child?

Nothing. It is not yet known what the causes are or how it can be prevented.

Do my other children need screening for UPJ obstruction?

Only if they show symptoms. Occasionally there have been cases where a family may have several members suffering from UPJ obstructions but the vast majorities are individual cases.

Is my baby in pain because of a UPJ obstruction?

The general belief is that most children are not in pain unless the urine becomes infected or the obstruction becomes worse.

Can my child participate in athletics later?

If the other kidney is normal and the affected kidney responds to treatment most experts feel that children can participate in athletics normally. 

Can the obstruction come back?

Not usually. Once it is repaired almost all kidneys continue to work well. Occasionally a child with a partial obstruction as an infant that improved without surgery will return later with symptoms that require surgery.

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