Ureteropelvic Junction (UPJ) Obstruction occurs when there is a blockage at the junction of the renal pelvis and ureter of the kidney. The renal pelvis, situated at the upper end of each ureter (the tubes that carry urine from the kidneys to the bladder), collects urine. Normally, each kidney has one ureter. The kidneys filter blood, removing waste and excess water to produce urine. This urine accumulates at the UPJ and then flows down the ureters into the bladder. For effective diagnosis and treatment of this condition in children, consulting the Best Pediatric Urologist in Gurgaon is crucial to ensure optimal care and management.
In UPJ obstruction, the flow of urine is either slowed or completely blocked. This condition increases the risk of kidney damage. Typically, only one kidney is affected in most cases of UPJ obstruction.
How Common is UPJ Obstruction?
UPJ obstruction occurs in approximately one out of every 1,500 births and accounts for about 80% of all cases where the urine-collecting systems are swollen. Males are affected more frequently than females, with the left kidney being affected about twice as often as the right.
Symptoms and Causes
Symptoms of UPJ Obstruction:
– Abdominal lump
– Pain in the upper abdomen or back, usually after drinking fluids. This pain results from urine backup, putting pressure on the kidney and surrounding tissues. Sometimes, the pain may be intermittent if the blockage is partial, allowing urine to flow at times.
– Urinary tract infection accompanied by fever
– Blood in the urine
– Vomiting
– Poor growth in infants
– Secondary Kidney stones
Causes of UPJ Obstruction:
Most cases of UPJ obstruction are present at birth, indicating that the structures of the ureter or kidney did not develop correctly during fetal growth. In some instances, there may be a genetic predisposition within families, though typically only one family member is affected. Various types of obstructions present at birth include:
– Narrow ureter opening
– Errors in the number or arrangement of muscle cells in the ureter responsible for urine propulsion
– Abnormal folds in ureter walls acting as valves
– Twists in the ureter
– High connection of the ureter to the renal pelvis, creating an abnormal angle
– Abnormal crossing of blood vessels causing pressure or distortion at the UPJ
Diagnosis and Tests
Diagnosis of UPJ Obstruction:
– Pre-birth ultrasound can detect UPJ obstruction by observing kidney swelling (hydronephrosis) caused by urine backup.
– Post-birth tests include blood and urine samples (such as BUN and creatinine tests) to assess kidney function.
– Imaging tests such as ultrasound, nuclear renal scan, and CT scan can identify kidney obstructions and evaluate kidney, ureter, and bladder structure.
Management and Treatment
Treatment of UPJ Obstruction:
In many infants, UPJ obstruction improves within the first few years of life without intervention. Regular ultrasounds and scans monitor progress to prevent lasting kidney damage.
If the obstruction persists and/or increases with time and the urine flow does not improve, surgery is typically required. Pyeloplasty is the recommended surgery, where the blockage at the UPJ is removed, and the ureter is reattached to the renal pelvis with a wider opening to promote free urine drainage and alleviate symptoms. It can be performed either by open or minimally invasive methods, using a laparoscope or robot.
Post-Treatment Outlook:
Pyeloplasty has a success rate of about 99%, with patients typically staying in the hospital for two to three days post-surgery. A drainage tube may be placed to assist urine flow during recovery.
Prevention
There is no known dietary or nutritional link to prevent UPJ obstruction in developing fetuses or for its improvement later in life.