If there is a full or partial blockage in the area where urine is produced by the kidneys and sent to the bladder, it’s referred to as a ureteral-pelvic junction or uretero-pelvic junction (UPJ). More common in children than adults, UPJ affects an area known as the renal pelvis, or the enlarged portion of the ureter. If the obstruction is mild, it usually resolves itself, although a urologist may prescribe antibiotics to prevent infection.
- With severe or problematic obstructions, surgery is usually the recommended treatment.
- There are two common options: an endopyelotomy and laparoscopic pyeloplasty.
Diagnosis and Assessment
Patients with ureteral/uretero pelvic junction often experience symptoms that include blood in urine (hematuria), kidney stones, abdominal discomfort, and urinary tract infections. Prior to recommending a treatment option when UPJ is suspected, testing is done to determine the extent of the obstruction and to rule out other possible conditions or structural issues that may be impeding urine flow. Blood, urine, and image tests are typical done to confirm the obstruction and assess how serious it is.
Endopyelotomy
An endopyelotomy is a minimally invasive endoscopic procedure done to remove the renal pelvic blockage. A special surgical balloon with an electric wire or a telescope is inserted to reach the affected area. Scar tissue that’s causing the obstruction is cut away. Because smaller incisions are made, an endopyelotomy can often be performed as an outpatient procedure by a urologic surgeon.
A temporary stent remains in place for four to six weeks to prevent scar tissue from reforming. Patients often benefit from a shorter recovery period than what’s common with traditional open surgery. Antibiotics need to be taken while the stent is in place to prevent infection. Some patients may experience blood in their urine post-surgery. This is normal and usually goes away within a few days.
Laparoscopic Pyeloplasty
If the blockage is severe and not likely to be corrected with endoscopic scar tissue removal, a laparoscopic pyeloplasty may be done. It’s also a minimally invasive procedure involving smaller incisions and special instruments. During the surgical reconstruction procedure, the blockage is removed and the original ureter that’s affected is reconnected to healthy renal pelvic tissue once the abnormal part of this tube is removed. It’s strategically repositioned to allow for normal urine flow.
In some situations, a urology surgeon may leave a stent in place for a week or so to allow for sufficient drainage of the ureter. A kidney catheter (nephrostomy) is sometimes used instead. Another option is place a rubber drain (Penrose drain) under the incision site. When performed on children, a caudal or epidural nerve block is sometimes done to minimize discomfort. Success rates for this procedure are greater than 90 percent.
When surgical treatment for UPJ is successful, patients are periodically monitored every three to six months with blood and urine tests and a renal ultrasound to ensure that kidney functions are normal. Follow-up testing may also involve specialized tests to check urine flow. Most children treated for UPJ are able to return to an active, productive lifestyle once proper urine flow from the affected kidney to the attached ureter is restored.