Ureteropelvic junction obstruction is a condition where the blockage occurs at a point where the ureter attaches to the kidney. This leads to a decrease in the flow of urine down the ureter and thus increases the fluid pressure inside the kidney. Higher pressure inside the kidney leads to deterioration of kidney function. This is a congenital condition, where the tube has not formed normally during the development phase. Your doctor will suggest the best treatment plan for your depending upon your health and medical history.
Most of the time, the blockage is caused when the connection between the ureter and the renal pelvis does not develop normally and causes urine to build up, possibly damaging the kidney. The condition can also be caused when a blood vessel is located in the wrong position over the ureter, causing a kink in the ureter. In older children and adults, ureteropelvic junction obstruction can be due to scar tissue, infection, previous treatments for a blockage, or kidney stones. Ureteropelvic junction obstruction is the most frequently diagnosed cause of urinary obstruction in children. It is now commonly diagnosed during prenatal ultrasound studies. In some cases, the condition isn't seen until after birth. Children may have an abdominal mass, urinary tract infection, or pain in the stomach or side.
There may not be any symptoms. When symptoms occur, they may include:
An ultrasound during pregnancy may reveal kidney problems in an unborn baby. Tests after birth may include:
The most severe cases of ureteropelvic junction obstruction may require surgery early in life, while many do not require early surgery.
Regular testing is required to make sure the kidney is still functioning properly. If the function of the kidney appears to be getting worse, or the obstruction is getting worse, surgery may be recommended.
Surgery to correct the blockage allows urine to flow normally and can be performed using open methods (incision) or laparoscopic methods. Both methods are called pyeloplasty and involve removing the abnormal part of the ureter and reconnecting it to the kidney to permit normal urine flow.
Open surgery is performed at all ages and involves an incision in the side or back to get to the kidney and remove the blockage, then repair the ureter.
Laparoscopic surgery, a minimally invasive technique, can now be used in all ages, and usually involve the assistance of robotic surgery to help with the delicate repair. The success rates of both are similar, but children having a laparoscopic procedure can usually return home sooner and are back to normal activity sooner.
A tube called a stent may be placed to drain urine from the kidney until the patient heals. A nephrostomy tube, which is placed on the patient's side to drain urine, may also be needed for a short time after the surgery. This type of tube may also be used to treat severe infections before surgery.