|
Ureteropelvic Junction Obstruction
What is
Ureteropelvic Junction Obstruction?
The
most common cause of obstruction (blockage) in
the urinary tract in children is a congenital
obstruction at the point where the ureter joins
the renal pelvis - the ureteropelvic junction (UPJ).
In UPJ obstruction, the kidney produces urine at
a rate that exceeds the amount of urine able to
drain out of the renal pelvis into the ureter
and this causes accumulation of urine within the
kidney.
Back to Top
Effects
of Ureteropelvic Junction Obstruction
This
procedure will relieve the obstruction in the
ureter.
Back to Top
Candidates for Ureteropelvic Junction
Obstruction
This problem occurs in approximately one in
1,500 children. These obstructions develop
prenatally as the kidney is forming and today
most are diagnosed on prenatal ultrasound
screening.
Back to Top
Your Consultation
Confirming the diagnosis is straightforward.
Either IVU (intravenous urogram - Xray study) or
a CT scan will show a sluggish, stretched-out
kidney pelvis with little drainage of the IVU
dye from the kidney to the ureter. Next, a renal
scan will look at the kidney function and
measure the transit time of the injected dye
from the kidney to the bladder. The transit time
of the dye is normally under 10 minutes but can
be as long as hours in the blocked kidney.
Back to Top
The
Ureteropelvic Junction Obstruction Procedure
The classic treatment of UPJ obstruction is an
open operation to remove the UPJ and to reattach
the ureter to the pelvis of the kidney creating
a wide junction between the two. This operation,
called a pyeloplasty, allows rapid and easy
drainage of urine produced by the kidney and
relieves symptoms and the risk of infection. The
procedure usually takes a few hours and has a
success rate in excess of 95 percent with one
operation. Hospitalization after surgery depends
on age of the patient. There are a variety of
drainage tubes utilized to promote healing and
their use is dependent on the surgeon's
preference. The incision is usually just below
the ribs and just behind a line that would pass
from the patient's arm to their leg on the
affected side. The incision is usually two to
three inches long.
Newer treatment of UPJ obstruction involves
minimally invasive surgery. There are two
options, a laparoscopic pyeloplasty and an
internal incision of the UPJ. Laparoscopic
surgery is done by placing several instruments
through the abdominal wall and performing the
surgical procedure. This procedure is most often
done through the abdominal cavity and has the
disadvantage of potentially causing scarring or
adhesions within the abdomen. Surgeons also
cannot utilize techniques that are as delicate
in a laparoscopic as in an open procedure. The
clear advantages of laparoscopic surgery are
less pain and nausea especially in older
children and adults. Success rates of
laparoscopic pyeloplasty are just being
determined but we would expect that they would
approach the effectiveness of open surgery with
time. The second option is to insert a wire
through the ureter and use it to cut the tight
and narrow UPJ from the inside. A special
ureteral drain is then left in place for several
weeks and then removed. The UPJ heals in a more
open manner in most patients but the treatment
may need to be repeated and success rates are
clearly less than those of open surgery. The
advantages of this procedure are less pain and
nausea.
Back to Top
Recovery
The
surgeon usually obtains a functional test, a few
weeks after the procedure, to evaluate how well
the kidney is working. Patients usually recover
quickly from any of the procedures but some have
pain for a few days following surgery and
occasionally a drainage tube must be left in
place to help drain the kidney while it heals.
The appearance of the kidney can continue to
improve for years but usually it never looks
normal on ultrasound or other studies. Once
repaired, a UPJ obstruction almost never recurs.
There is nothing that the family can do to
prevent further problems with the kidney.
Back to Top
Risks
After repair of UPJ
obstruction, there is usually swelling of the
ureter and continued poor drainage of the kidney
for a period of time. This usually changes as
the area heals.
Patients may have a slightly increased risk of
developing stones and infection throughout their
lives because many of the kidneys still contain
some pooled urine even though their overall
drainage is improved after surgery.
Back to Top
Frequently Asked Questions
Q:
What are the symptoms of UPJ?
A:
UPJ obstruction usually has symptoms of back
pain, multiple kidney infections, and/or kidney
stone formation. Other symptoms include polyuria
(excessive urination) and nocturia (frequent
nighttime urination).
Q:
What happens when I have UPJ?
A:
Blockage of the ureter can be congenital
(something one is born with) or acquired.
Congenital causes include malformation of the
ureteral muscle, which cannot function to help
push urine down to the bladder. This is more
common in children. In adults, an extra artery
or vein to the lower portion of the kidney can
cross over the ureter as it exits the kidney
causing a slow, progressing kinking which leads
to obstruction. Both of these congenital
entities are known as ureteropelvic junction
obstruction or UPJ.
Q:
What is laparoscopic pyeloplasty?
A:
Laparoscopic
pyeloplasty
is a minimally invasive approach to the standard
open pyeloplasty. The surgery involves
cystoscopy (looking in the bladder), stent
placement (drainage tube in the ureter), and
reconstruction and re-connection of the ureter
through three small puncture holes. The
procedure has a 95% success rate.
Q:
Can the obstruction come back?
A:
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
Back to Top
The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
|
