Page 2 - Ureteropelvic Junction Obstruction

Ureteropelvic junction obstruction
Your urologist may recommend a cystoscopy and
retrograde pyelography. This involves passing a
narrow visualizing instrument (scope) through the
urine passage (urethra) into the bladder. The kidney
drainage system is then filled from below with contrast
material to allow detailed x-ray imaging.
The degree of blockage may vary from minimal to
severe and, occasionally, it may come and go.
Treatment
In some cases, particularly in infants, UPJ obstruction
may be mild and not require any treatment. Unless
very severe, UPJ obstruction found in newborns often
can be safely observed without treatment because,
frequently, the blockage will resolve on its own as the
child matures. Your urologist will recommend periodic
monitoring with lab tests, ultrasound and nuclear
kidney scans. A small daily dose of antibiotic may be
advised in newborns to prevent urinary infection that
could damage the kidney.
Treatment may be required when symptoms are
bothersome or kidney function is impaired by the
obstruction.
In some, temporary kidney drainage can be obtained
with an internal or external drainage tube. A ureteric
stent is an internal drain running from the renal pelvis
to the bladder within the ureter, while a nephrostomy
tube drains from the renal pelvis out through the flank
into a bag. This can allow treatment of infection,
preservation of kidney function or relief of pain while
corrective surgery is being planned.
Corrective surgery aims to reconstruct a gradual
tapering of the ureteropelvic junction to allow
unobstructed funneling of urine from the renal
pelvis to the ureter. Various surgical techniques are
available to correct UPJ obstruction. Your urologist
will recommend the procedure most suitable to your
specific circumstances.
UPJ obstruction is repaired with an operation called a
pyeloplasty done under general anesthesia (you are
put to sleep). Traditionally, an incision was made in
the flank through which the renal pelvis and ureter are
exposed. The narrow UPJ is cut out or cut open and a
wider connection is constructed. A temporary stent or
nephrostomy tube may be placed. Patients may be in
hospital for up to seven days and able to resume their
usual activities within four to six weeks. This operation is
successful in about 90% of cases.
Pyeloplasty
kidney
renal stent
UPJ pelvis
removed
ureter ureter
bladder
Roula Drossis
Pyeloplasty
Today, in most occasions it is possible to perform the
pyeloplasty by laparoscopy. A series of “keyhole”
incisions are made in the abdomen through which a
narrow video camera and operating instruments are
used to reconstruct the UPJ. This operation, although
technically challenging, allows a shorter hospital stay
and recovery time.
Another alternative in adults is endopyelotomy,
which involves making a cut through the area of
obstruction in the UPJ using a scalpel, electric current
or laser passed into the drainage system through a
“scope”. In a percutaneous endopyelotomy, a small
incision is made in the flank through which a scope is
advanced through the kidney into the renal pelvis to
incise the UPJ. Ureteroscopic endopyelotomy involves
passing a scope through the urethra, bladder and
ureter to incise the UPJ. With either approach, a stent
is required for several weeks postoperatively. These
techniques may not be possible in all cases and have
a success rate of about 70-80%.
If your kidney has very poor function, your urologist
may recommend its removal (nephrectomy) rather
than repair.
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