Ureteropelvic junction (UPJ) obstruction is a condition that is characterized by a blockage at the ureteropelvic junction (the point where the pelvis of the kidney meets the ureter). The ureter is a thin long, tube-like structure that carries urine from the kidney and drains it into the bladder.
The obstruction can either be congenital (present since birth), secondary to trauma, or a change in body shape as you age. The blockage slows or halts the urine flow, which may eventually increase the pressure within the kidney, forming scar tissue at the obstruction. Excess pressure within the kidney can damage it and impair its function.
Ureteropelvic junction (UPJ) obstruction is a blockage in the renal pelvis of the kidney (area at the center of the kidney), a funnel-shaped part that collects urine. The urine is then drained into the bladder through peristalsis (involuntary contraction and relaxation of the muscles around).
Any obstruction in this junction, present congenitally or secondary to trauma, can create urine buildup within the UPJ, increasing the pressure inside the kidney.
This dilates the kidney (hydronephrosis) and causes permanent damage, impairing the renal (kidney) function. Ureteropelvic junction obstruction in infants usually does not require treatment since it resolves on its own within the first 18 months of life.
However, surgery may be recommended in infants if the urine flow does not improve. Medical treatment has no role in adults, and surgical intervention is required in UPJ Obstruction. The surgical methods include:
Ureteropelvic junction obstruction is commonly seen among infants that may be present congenitally. The structures of the kidney and ureter fail to form normally as the fetus develops. The obstruction can be easily detected in an ultrasound scan where the affected kidney appears swollen (hydronephrosis). This is due to the fact that the presence of UPJ obstruction causes more than normal production of urine, which pools around the kidney pelvis, thereby abnormally enlarging the kidney.
In some cases, UPJ obstruction can also occur as an inherited condition (running in the family and passed down through generations).
When UPJ obstruction occurs in adults, it is generally due to:
The symptoms of UPJ depend on the age of the patient and differ in adults and children.
Most often, the obstruction in infants can be identified through routine pregnancy scans that present with hydronephrosis (abnormal swelling of the affected kidney).
Other potential symptoms include:
You may need to undergo various tests to confirm the diagnosis and evaluate the severity of the condition.
Ureteropelvic junction obstruction in infants does not require treatment since they can outgrow the condition within 18 months of life. However, antibiotics may be prescribed to prevent infection. Persistent obstruction with poor urine outflow and increased risk of kidney damage require surgical intervention. Medical treatment is not recommended in adults, and surgical intervention is necessary to treat UPH Obstruction.
The different surgical methods are as follows:
New research is underway for laser endopyelotomy (LEP) with high success rates and low risk of complications.
Complications could develop if the ureteropelvic junction obstruction is left untreated and may also arise post-surgery.
Complications of UPJ Obstruction:
Complications of Surgical Management of UPJ Obstruction:
Congenital ureteropelvic junction obstruction cannot be prevented since there is no link between the pregnant mother's diet and the formation of the UPJ obstruction. However, adults not born with UPJ obstruction should reduce their risk of developing it later. Hence avoid:
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Ureteropelvic junction obstruction is seen in about 1 out of 1,500 births. It is most commonly seen in male infants compared to female infants, with the left kidney being affected about twice as often as the right kidney.
Ureteropelvic junction obstruction surgeries are of four types- endopyelotomy, open pyeloplasty, laparoscopic and robotic pyeloplasty. The success rates of these procedures range up to 98% which, depends on the age of the patient and the surgical skills of the urologist.
It usually takes 15 to 20 days to fully recover from the procedure. You can often return to normal activity as early as 2 to 4 weeks post-surgery. However, avoid lifting heavy objects and strenuous exercises and activities for 4 to 6 weeks.
Stents placed during UPJ surgery are usually removed 6 weeks post-surgery through a procedure known as cystoscopy. A small camera is placed inside the bladder to grasp and remove the stent. The procedure usually takes about 5 minutes.
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