What is UPJ Obstruction? Treatment of UPJ obstruction.
Ureteropelvic junction (UPJ) obstruction refers to the blockage of normal urine from the kidney to the bladder. UPJ obstruction occurs at the point where the kidney joins the ureter. Ureters are small tubes (less than 5 mm in diameter) that connect the kidney to the bladder.
UPJ obstruction occurs most often in children and prevents the proper flow of urine, thereby threatening the integrity of the kidney. UPJ obstruction can also occur in adults.
In children, UPJ obstruction is often present at birth and may be due to narrowing of the proximal ureter or the presence of an abnormal blood vessel over the ureter.
Symptoms of UPJ obstruction may include infection of the kidney or urinary tract, fever, vomiting, bloody urine, abdominal masses, and back pain or abdominal pain.
In adults, UPJ obstruction may present with symptoms similar to kidney stones such as back pain. Kidney stones may also co-exist with UPJ obstruction.
Treatment Options for UPJ Obstruction
Prompt detection and effective treatment strategies for UPJ obstruction are critical to prevent or minimize long-term damage to the kidney. Whereas open surgery procedures comprised first-line treatment strategies in the past, less invasive endo-urological and laparoscopic techniques have recently become popular interventions for UPJ obstruction. For some patients who have symptomatic UPJ obstruction and minimal kidney function, removal of the non-functioning kidney may be a good option.
- Robotic / Laparoscopic Pyeloplasty
- Open Pyeloplasty
- Ureteral Stent
Which Treatment Option for UPJ is Best?
A variety of open surgical procedures have been performed, the most common being the Anderson-Hynes dismembered pyeloplasty, which has a high success rate, as much as 95% and is therefore used as a barometer to compare the utility of less invasive techniques. Pyeloplasty has been performed laparoscopically since 1993. Today, laparoscopic pyeloplasty is most often performed robotically using the DaVinci Robot with success rates that are equivalent to open procedures.
Endourological treatments, such as endopyelotomy have slightly lower long-term success rates and are usually reserved for patients who are not good candidates for laparoscopic repair.
In some patients, typically very elderly who cannot tolerate surgery, an indwelling ureteral stent may be a reasonable treatment option.
The da Vinci robot use for pyeloplasty improved patient outcomes and reduced associated complications.
What Complications May Arise if UPJ Obstruction is not treated?
Patients with UPJ obstruction are at increased risk for developing kidney stones. A urinary infection has been proposed to cause kidney stones in patients with UPJ obstruction. Urinary infections should be treated appropriately.
For patients with kidney stones in the presence of UPJ obstruction, the versatility of laparoscopic procedures allows them to be combined with endoscopy to personalize treatment to render patients stone-free at the time of treatment for UPJ obstruction.
Sometimes kidney stones may need to be addressed before or after pyeloplasty depending on the particular situation.
With stones located in the UPJ, a number of treatment strategies are available. Stone size is a major predictor of the success of each treatment option. For example, for most patients, the best approach for stones up to 1 centimeter is often with extracorporeal shockwave lithotripsy, whereas the best success for larger stones has been demonstrated with percutaneous nephroureterolithotripsy (PCNL).
Will the Kidneys Be Affected Long-Term?
Treatment of UPJ obstruction is highly effective. Urologists assess obstructions with nuclear renal scans to determine the best treatment option for each patient. In some cases, the kidney may have to be removed in what is known as a nephrectomy, if the kidney has no function and causes symptoms such as pain, infections, kidney stones.
Dr. Alex Shteynshlyuger is an experienced surgeon who uses advanced techniques individualized for the needs of each patient for treatment of UPJ obstruction including DaVinci Robot, endopyelotomy, and other techniques. Dr. Alex Shteynshlyuger was trained at some of the top hospitals in the United States for Urology. He is experienced in treating some of the most challenging problems in urology.