UPJ Obstruction and Other Congenital

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?