UPJ obstruction
Ureteropelvic Junction (UPJ) Obstruction is a condition where a blockage occurs at the junction where the pelvis of the kidney meets the ureter (the tube that carries urine to the bladder). Here’s a detailed overview:
Anatomy and Physiology
• Kidney Pelvis: The funnel-shaped structure where urine collects before moving into the ureter.
• Ureter: The narrow tube that transports urine from the kidney to the bladder.
• UPJ: The point where the kidney pelvis transitions into the ureter.
Causes
1. Congenital: Most common in children; present from birth due to abnormal development of the muscles or other structures at the UPJ.
2. Acquired: Can occur due to kidney stones, scar tissue from previous surgeries or infections, tumors, or other external compressions.
Symptoms
• Pain: Flank pain, especially during periods of increased fluid intake or after drinking alcohol.
• Hydronephrosis: Swelling of the kidney due to urine buildup.
• Urinary Tract Infections: Recurrent UTIs due to impaired urine flow.
• Hematuria: Blood in the urine.
• Lump in the abdomen: In severe cases, a palpable mass may be felt.
Diagnosis
1. Ultrasound: Initial imaging test to detect hydronephrosis.
2. CT Scan: Provides detailed images of the urinary tract.
3. MAG3 Lasix Renal Scan: Measures kidney function and the degree of obstruction.
4. MRI Urography: Detailed imaging to visualize the UPJ and urinary tract.
5. Voiding Cystourethrogram (VCUG): X-ray study of the bladder and urethra during urination.
6. Intravenous Pyelogram (IVP): X-ray with contrast to visualize the urinary tract.
Treatment
1. Observation: Mild cases may be monitored with regular imaging and kidney function tests.
2. Endopyelotomy: Minimally invasive procedure where a small incision is made at the UPJ to relieve the blockage.
3. Pyeloplasty: Surgical reconstruction of the UPJ to remove the obstruction and reattach the healthy ends.
• Open Pyeloplasty: Traditional surgery with an incision.
• Laparoscopic Pyeloplasty: Minimally invasive approach with small incisions and a camera.
• Robot-assisted Pyeloplasty: Utilizes robotic technology for precision.
4. Nephrostomy Tube: Temporary drainage tube inserted into the kidney to relieve obstruction.
5. Balloon Dilation: A balloon is inflated at the site of obstruction to open the UPJ.
Prognosis
• Children: Excellent outcomes with early intervention. Most congenital UPJ obstructions can be effectively treated.
• Adults: Varies depending on the cause and severity. Surgery often provides relief and preserves kidney function.
Follow-up
• Regular imaging and kidney function tests to monitor for recurrence or complications.
• Monitoring for potential post-surgical complications like infection or scarring.
Complications
• Kidney Damage: Prolonged obstruction can lead to permanent damage.
• Infections: Increased risk of urinary tract infections.
• Recurrent Obstruction: Possible in some cases, requiring further treatment.
Would you like a more detailed explanation on any specific aspect or have any additional questions?