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Ureteropelvic junction obstruction (UPJ) is a congenital condition that can also develop in adults, causing urinary tract blockage. Mild cases may resolve on their own, but severe cases may require surgery such as pyeloplasty, which can be done openly or laparoscopically. Detection usually occurs in utero or through imaging tests. Symptoms in children can mimic UTIs.
Ureteropelvic junction obstruction (UPJ) is a blockage that affects urinary tract function. Usually a congenital condition, ureteropelvic junction obstruction, can also develop in adults with conditions that negatively affect ureteral function. Treatment for ureteropelvic junction obstruction generally depends on the severity of the blockage. The condition can regress without treatment, but blockages that threaten kidney function and health may require surgical correction.
Considering that most cases of ureteropelvic junction obstruction are congenital, detection occurs while the fetus is in utero. Ultrasounds usually show hydronephrosis, or renal distention, where the ureter joins the base of the kidney, called the ureteropelvic junction. Testing for UPJ obstruction outside the uterus may include administering an intravenous pyelogram (IVP), which uses imaging technology and contrast medium to evaluate the condition and function of the urinary tract. A kidney scan may also be done to evaluate the degree of ureteral obstruction.
Anatomically speaking, the ureters are double tubes that carry urine from the kidneys to the bladder. Each associated with its respective kidney, abnormal urethral constriction with abnormal growth or inflammation may occur. Congenital presentations of urethral narrowing usually arise from a malformation, that is, an unusual narrowing, of the urethral tube.
Early childhood presentations of ureteropelvic junction obstruction generally cause symptoms that mimic those associated with a urinary tract infection (UTI). It is not uncommon for a child to pass dark or blood-stained urine, display abdominal distension, or experience discomfort when urinating. Some children may also experience frequent urinary tract infections accompanied by abdominal cramps and discomfort.
It is entirely possible for mild blockages to subside on their own without treatment. If the obstruction is mild, regular monitoring may be used to determine if ureteral function improves. When ureteropelvic junction obstruction worsens or threatens kidney or bladder function, surgery may be done.
Pyeloplasty is the surgical removal of the urethral blockage and repositioning of the ureteral tube to facilitate proper urinary tract function. By detaching the affected urethal tube from the kidney, the surgeon will excise the narrowed tissue and reattach the remaining urethal tube to the kidney. If the urethral tube has been damaged or weakened by prolonged stretch, short-term stent placement can be performed to reinforce the compromised tissue. Once the ureter adjusts, the stent is removed.
A pyeloplasty procedure can be done openly with a single incision or laparoscopically with several small incisions. Both surgical approaches require hospitalization and carry the risk of complications, including infections. Although laparoscopy is used more frequently, the severity of your condition and general health will generally determine the type of surgery.
