Ureteropelvic Junction Obstruction
What is it?
Ureteropelvic junction obstruction is a
blockage in the area where the ureter and the
renal pelvis meet. The ureter is the tube that
carries urine from the kidney to the bladder. The
ureter drains the urine from a collecting area,
called the renal pelvis.
Who gets it?
Ureteropelvic junction obstruction is seen in
children more often than adults.
What causes it?
Ureteropelvic junction obstruction can be
caused by a congenital defect, which means the
abnormality is present at birth. What causes the
congenital defect is unknown. In adults, the
blockage can develop because of kidney stones, an
upper urinary tract inflammation, scarring from a
past surgery, or a tumor.
What are the symptoms?
Ureteropelvic junction obstruction causes
sudden pain in the side, usually after drinking
large quantities of fluids. The kidneys produce
urine more quickly than the ureters can drain it
from the renal pelvis because of the blockage. The
kidneys enlarge (distend), creating pressure in
the pelvis. The distention caused by the
accumulation of urine in the kidneys is called
hydronephrosis. Ureteropelvic junction obstruction
may also cause blood in the urine (hematuria),
high blood pressure (hypertension), and frequent
urinary tract infections (UTIs). If the kidneys
are in a state of hydronephrosis for too long, the
kidney tissues become damaged, resulting in the
gradual loss of kidney function.
How is it diagnosed?
Ureteropelvic junction obstruction can be
diagnosed through a procedure called intravenous
urography. A substance is injected into the
bloodstream before x-rays are taken of the
kidneys. The substance is visible on the x-ray,
and shows the shape of the kidney, the ureter, and
renal pelvis. Other tests may include differential
radioisotope renography, percutaneous nephrostomy,
and differential creatinine clearance collection.
Doctors can detect hydronephrosis from a prenatal
ultrasound, which is performed during pregnancy,
so the possibility of ureteropelvic junction
obstruction can be diagnosed before the baby is
born. To confirm the diagnosis after birth,
doctors test the ability of the kidney to produce
and drain urine. In infants, the dilated kidney
can be felt by gently pressing on (palpating) the
newborn’s abdomen in the kidney area. The
furosemides renal scan is another diagnostic test
used with children. With this test, a radioactive
substance is injected into the bloodstream and
followed through the kidneys with a special
camera.
What is the treatment?
Ureteropelvic junction obstruction can often be
repaired surgically. The obstruction is removed
and the ureter is reattached to the renal pelvis.
This type of surgery is called pyeloplasty.
Laparoscopic surgery and a procedure in which a
wire is inserted through the ureter to cut the
blockage are less invasive options. After surgery,
it does take some time for the ureter to heal and
kidney function to return to normal. However,
ureteropelvic junction obstruction rarely recurs.
Removal of the kidney may be recommended in cases
where the obstruction is so severe that kidney
function is lost. If your child has ureteropelvic
junction obstruction at birth, your doctor may
recommend repeated ultrasounds and CT scans to
evaluate the condition during his or her first 18
months of life before treatment, depending upon
the size of the obstruction and the degree of
kidney function. In some cases, the condition may
improve without treatment.
Self-care tips
It’s important to recognize the signs of
ureteropelvic junction obstruction and get
immediate treatment because it can cause permanent
damage to the kidneys.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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