What is Ureteropelvic Junction (UPJ) Obstruction?

Ureteropelvic junction (UPJ) obstruction is a blockage in the junction, which connects the ureter to the kidney. The ureter is a long, tube-shaped structure that conveys urine from the kidney to the bladder. A UPJ obstruction reduces the flow of urine and increases fluid pressure within the kidney. Persistent increased stress on the kidneys can lead to kidney damage.

Symptoms

Some of the symptoms of ureteropelvic junction obstruction are observable. Other symptoms may not be physically noticeable.

UPJ obstruction symptoms include:

• Kidney stones
• Vomiting
• Fever
• Bloody urine
• Mass in the abdomen
• Urinary tract infection
• Back pain or discomfort
• Abdomen pain or discomfort
• Slow growth an in infant

After drinking liquids, you might experience pain in your back, side, or upper abdomen because of fluid backup in your kidney. The pain can be persistent or sporadic.

Causes

Ureteropelvic junction obstruction is generally congenital or present at birth. There is no known way to prevent UPJ obstruction.

Diagnosis

A ureteropelvic junction (UPJ) obstruction might be diagnosed before or after birth. A variety of tests can lead to a ureteropelvic junction obstruction diagnoses.

Types of UPJ tests:

• Ultrasound: Medical imaging test that uses sound waves to capture images of the ureter, junction and kidney.
• Computed Tomography (CT) scan: It uses a variety of X-rays and a medical computer to create a 3D image of your kidneys, ureters and bladder.
• Magnetic Resonance Imaging (MRI) scan: An MRI scan involves a special oversized magnet, radio waves, and a computer to create precise images of your anatomy.
• Blood Urea Nitrogen (BUN) and Creatinine Tests: These tests gauge your blood urea nitrogen levels.
• Intravenous Pyelogram (IVP): This is a special test that uses an X-ray and an injection of contrast dye to assess your kidneys, ureters and bladder.
• Nuclear Renal Scan: A nuclear renal scan uses radioactive gamma rays to evaluate your kidney function.

Treatment

UPJ obstruction treatment without surgery is possible. UPJ may naturally resolve during the first 18 months of life. In this case, surgery is not required. However, if the condition doesn't change or symptoms worsen, UPJ obstruction surgery is likely needed.

UPJ treatment might involve:

• Pyeloplasty: A pyeloplasty is an operation that extracts scar tissue from the blockage, and then attaches the undamaged section of the kidney to the healthy ureter.
• Laparoscopic pyeloplasty: A laparoscopic pyeloplasty is a robot-assisted procedure using several small incisions.
• Internal incision: A surgeon will use a special wire inserted through your ureter to make an incision from inside your body. Typically, a ureteral drain is kept inside your body and then removed a few weeks later.