Ureteral & Uretero-Pelvic Junction Treatment

Surgery for ureteral and uretero-pelvic junction can correct the problem quickly.

Urethral and uretero-pelvic junction obstruction (UPJ) is a total or partial blockage at the point where the kidney, in which urine is made, and the ureter, in which urine flows down to the bladder, join together.

• This condition may occur in children or adults
• It is treatable through corrective surgery

Causes

In children, UPJ is frequently detected even before birth. A prenatal ultrasound may show that the fetus has enlarged kidneys (also known as hydronephrosis) due to a blockage of urine outflow. This is the most common type of UPJ and can run in families. After birth, the child's kidney output will be closely monitored and watched for improvement, because many cases of congenital UPJ resolve themselves. If a marked decline is observed or function does not improve, the child may be a candidate for surgery.

UPJ also occurs in adults, with causes ranging from kidney stone damage to abnormal blood vessels to tumors. The most common cause in adults is the so-called abnormal blood vessel development, usually a vein. This situation is known as a "crossing vessel" because it drapes itself directly over the ureter right at the ureteropelvic junction. As the patient grows older, the vein can enlarge and eventually become a real impediment to outflow.

Sometimes the cause of UPJ remains unknown, because all that is left at the junction is scar tissue. That scar tissue will narrow the pathway through which urine can flow (known as a "stricture") and causes it to be made at a higher rate than it can flow out to the bladder.

Symptoms

In newborns, UPJ may cause failure to thrive or few wet diapers. The symptoms will depend on the severity of the UPJ and whether it resolves by itself or not. The wait-and-see approach shows improved outcomes in many children who end up not needing surgery.

In adults and older children, signs may include frequent urinary tract infections, kidney infections, hematuria (blood in the urine), kidney stones, abdominal discomfort, abdominal mass, and possibly flank or back pain.

Treatment Options

While a young child's UPJ may correct itself, severe cases in children and most cases in adult patients require surgery. Traditional open surgery to remove the blockage and repair the ureteropelvic junction is known as a pyeloplasty. This technique is still best for more severe cases of UPJ and for very young patients. Drainage tubes will be used afterward to help heal the site.

While a young child's UPJ may correct itself, severe cases in children and most cases in adult patients require surgery. Traditional open surgery to remove the blockage and repair the ureteropelvic junction is known as a pyeloplasty. This technique is still best for more severe cases of UPJ and for very young patients. Drainage tubes will be used afterward to help heal the site.