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    UPJ obstruction

    Ureteropelvic junction obstruction; UP junction obstruction; Obstruction of the ureteropelvic junction

    Ureteropelvic junction (UPJ) obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder (ureters). This blocks the flow of urine out of the kidney.

    Causes

    UPJ obstruction mostly occurs in children. It often happenswhen a baby is still growing in the womb. This is called a congenital condition (present from birth). The blockage is caused when there is a narrowing of area between the ureter and the part of the kidney called the renal pelvis. Urine can build up and damage the kidney as a result.

    The condition can also be an abnormal blood vessel over the ureter. In older children and adults, the problem may be due to scar tissue, infection, earlier treatments for a blockage, or kidney stones.

    UPJ obstruction is the cause of most urinary obstructions in children. It is now commonly detected before birth withultrasound tests. In some cases, the condition may not show up until after birth. Symptoms may include an abdominal mass or a urinary tract infection.

    Surgery may be needed early in life if the problem is severe. Most of the time, surgery is not needed until later. Some cases do not require surgery at all.

    Symptoms

    There may not be any symptoms. When symptoms occur, they may include:

    • Back or flank pain
    • Bloody urine (hematuria)
    • Lump in the abdomen (abdominal mass)
    • Kidney infection
    • Poor growth in infants (failure to thrive)
    • Urinary tract infection, usually with fever
    • Vomiting

    Exams and Tests

    An ultrasound during pregnancy may show kidney problems in the unborn baby.

    Tests after birth may include:

    • BUN
    • Creatinine clearance
    • CT scan
    • Electrolytes
    • IVP - less utilized tests
    • CT urogram - scan of both kidneys and ureters with IV contrast
    • Nuclear scan of kidneys
    • Voiding cystourethrogram

    Treatment

    Surgery to correct the blockage allows urine to flow normally. Most of the time, open (invasive) surgery is performed in infants. Adults may be treated with less-invasive procedures. These procedures involve much smaller surgical cuts than open surgery, and may include:

    • Endoscopic (retrograde) technique does not require a surgical cut on the skin. Instead, a small instrument is placed into the urethra. This allows the surgeon to open the blockage from the inside.
    • Percutaneous (antegrade) technique involves a small surgical cut on the side of the body between the ribs and the hip.
    • Pyeloplasty removes scar tissue from the blocked area and connects the healthy part of the kidney to the healthy ureter.

    Laparoscopy has also been used to treat UPJ obstruction in children and adults who have not had success with other procedures.

    A tube called a stent may be placed to drain urine from the kidney until the surgery heals. A nephrostomy tube, which is placed in the side of the bodyto drain urine, may also be needed for a short time after the surgery. This type of tube may also be used to treata bad infectionbefore surgery.

    Outlook (Prognosis)

    Detecting and treating the problem early can help prevent future kidney damage. UPJ obstruction diagnosed before birth or early after birth may actually improve on its own.

    Most patients do well and have no long-term problems. Serious damage may occur in people who are diagnosed later in life.

    Long-term outcomes are good with current treatments. Pyeloplasty has the best long-term success.

    Possible Complications

    If untreated, UPJ obstruction can lead to permanent loss of kidney function (kidney failure).

    Kidney stones or infection may occur in the affected kidney even after treatment.

    When to Contact a Medical Professional

    Callthehealth care provider if your infant has:

    • Bloody urine
    • Fever
    • A lump in the abdomen
    • Indications of back pain or pain in the flanks (the area towards the sides of the body between the ribs and the pelvis)

    References

    Pais VM, Strandhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 41.

    Singh I, Standhoy JW, Assimos DG. Pathophysiology of urinary tract obstruction. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 40.

    Elder JS. Obstruction of the urinary tract. In: Kliegman RM,Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 534.

    Frokiaer J, Zeidel ML. Urinary tract obstruction. In: Brenner BM, ed. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa ; Saunders Elsevier; 2007:chap 35.

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    • Kidney anatomy

      illustration

      • Kidney anatomy

        illustration

      Tests for UPJ obstruction

        Review Date: 5/7/2013

        Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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