The renal pelvis is located at the upper end of each ureter tube that drains urine from the kidneys to the bladder. Ureteropelvic junction upj obstruction is when part of the kidney is blocked. Upj obstruction is repaired with an operation called a pyeloplasty done under general anesthesia you are put to sleep. Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of hydronephrosis. This obstruction can lead to an increase in backpressure on the kidney, hydronephrosis, and progressive damage to the kidney function. Increased pressure inside the kidney can over time cause deterioration of kidney function. However, hydronephrosis now is usually diagnosed antenatally and affects approximately 1 in 1500. Although open pyeloplasty remains the gold standard, several endoscopic and laparoscopic techniques are available as alternative treatment options. The aetiology is thought to relate to an intrinsic developmental abnormality resulting in a short segment of aperistaltic smooth muscle at the upj. Materials and methods we identified pediatric patients diagnosed with upj obstruction by mru between may 2009 and june 2014. The reason for the surgery was ureteropelvic junction obstruction due to an hourglass deformity and dysplastic ureter. A mag3 mercaptoacetyltriglycine renal scan with furosemide. Ureteropelvic junction obstruction european urology supplements.
Ureteropelvic junction upj obstruction cleveland clinic. The ureteropelvic junction is located where the pelvis of the kidney meets the ureter the tube that drains urine into the bladder. Pe1751 ureteropelvic junction upj obstruction seattle childrens. Impact of etiology of secondary ureteropelvic junction.
The term ureteropelvic junction upj obstruction describes a blockage to this area. Evolution in the treatment of the ureteropelvic junction. Ureteropelvic junction obstruction european urology open science. Ureteropelvic junction obstruction ureteropelvic junction obstruction is commonly referred to as a upj obstruction. Ureteropelvic junction obstruction european urology. Ureteropelvic junction upj obstruction is a blockage or narrowing between the kidney pelvis and the ureter. The narrowing of the ureter can be partial or complete.
About one child in every births is diagnosed with a upjo. There are a variety of accepted treatments for primary or secondary ureteropelvic junction upj obstruction. Pelviureteric junction puj obstruction stenosis, also known as ureteropelvic junction upj obstruction stenosis, can be one of the causes of obstructive uropathy. Ureteropelvic junction obstruction ucsf medical center. Congenital ureteropelvic junction obstruction upjo is the most common cause of upper urinary tract obstruction in children. Ureteropelvic junction an overview sciencedirect topics. Ureteropelvic junction obstruction and coexisting renal calculi in children. Figure 1 what are the symptoms of a ureteropelvic junction obstruction. Ureteropelvic junction obstruction and parathyroid adenoma.
The renal pelvis is the part of the kidney that collects the urine made by the kidney and the ureter is the tube that carries the urine from the renal pelvis to the bladder see figure 1. This is where the kidney attaches to one of the ureters the tubes that carry urine to the bladder. Look in the alphabetic index for obstruction ureter functional pelvic junction congenital refers you to q62. Ureteropelvic junction upj obstruction is the most common obstructive uropathy in children. Pdf management of ureteropelvic junction obstruction in adults. Pelviureteric junction obstruction radiology reference. Ultimately, a ct scan performed during an acute pain crisis clearly. Chapter 89 congenital ureteropelvic junction stenosis. Pediatric ureteropelvic junction obstruction clinical.
Ureteropelvic junction obstruction is a condition where blockage occurs at the junction where the ureter attaches to the kidney. Currently, less invasive techniques are used for the treatment of ureteropelvic junction obstruction. This causes a decreased flow of urine through the ureter and an increase in fluid pressure inside the kidney. Ureteropelvic junction obstruction upjo is the most common cause of postnatal hydronephrosis. Ureteropelvic junction obstruction canadian urological association. Ureteropelvic junction obstruction upjo causes a reduction in the urine flow from the renal pelvis into the ureter. Management of ureteropelvic junction obstruction in adults.
Obstruction of the ureteropelvic junction ureteropelvic yuhreetuhroepelvik junction obstruction is a partial or total blockage of the flow of urine pee in the area where a ureter attaches to a kidney. Upj obstruction causes the pee urine to back up in the kidney. Aug 15, 2018 ureteropelvic junction upj obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 2000 newborns. The blockage seen in upjo is thought to be caused by a congenital narrowing of the ureteropelvic. Untreated disease can result in renal impairment making effective. When occurring in childhood, it is frequently bilateral 16%, associated with other urologic malformations 15% to 20%, predominantly on the left side, and predominantly in boys. 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. Delayed recognition of an ureteropelvic junction obstruction.
The obstruction impedes the flow of urine down to the bladder, causing the urine to back up in the kidney and dilate it. Ureteropelvic junction obstruction ucsf department of. A ureteropelvic junction obstruction is a partial blockage of the drainage system of the kidney. Ureteropelvic junction obstruction prevention cleveland clinic. Ureteropelvic junction obstruction ucsf department of urology. This is called a congenital condition present from birth. Although most cases are probably congenital in origin, the problem may not become clinically apparent until much later in life. Ureteropelvic junction obstruction is the most common cause of ureteral obstruction and may present at any age. Ultrasonography will reveal a dilated renal pelvis with or without caliectasis, and the absence of ureteral dilatation figure 842. The most common cause of obstruction blockage in the urinary tract in children is a. Ureteropelvic junction upj obstruction is a blockage at the junction where the ureter attaches to the kidney. Management of ureteropelvic junction obstruction with a duplex system is technically challenging even when laparoscopic procedure is the standard approach for ureteropelvic junction obstruction. Ureteropelvic junction upj obstruction may be defined as a functional or anatomic obstruction to urine flow from the renal pelvis to the proximal ureter. A ureteropelvic junction obstruction upjo is a blockage of urine flow from the renal pelvis to the ureter.
The renal pelvis, which is shaped like a funnel, collects urine. Endopyelotomy for secondary ureteropelvic junction obstruction upjo is a highly effective procedure. What we know and what we dont know hyeyoung lee, sang won han from the deparment of urology, urological science institute, yonsei university college of medicine, seoul, korea purpose. Chapter 89 congenital ureteropelvic junction stenosis chris heinick john lazarus introduction congenital ureteropelvic junction upj stenosis is a disturbance in the flow of urine at the crossover point from the kidney pelvis to the ureter, with a dilatated and obstructed renalpelvic calyceal system figure 89. When urine backs up in the kidney, the kidneys are no longer able to filter blood, remove waste products and make urine. The diagnosis of ureteropelvic junction obstruction upjo implies functionally significant impairment of urinary transport from the renal pelvis to the ureter.
Untreated upjo may cause hydronephrosis, chronic infection or urolithiasis and will often result in progressive deterioration of renal function. Ureteropelvic junction obstruction brigham and womens hospital. Ureteropelvic junction obstruction generally occurs when a baby is still growing in the womb. Prior to fetal ultrasonography, ureteropelvic junction obstruction upjo was most often identified in a child after evaluation revealed an abdominal mass, intermittent abdominal or flank pain and vomiting, or a urinary tract infection. Ureteropelvic junction upj obstruction is a blockage or narrowing between the kidney pelvis and. Ureteropelvic junction obstruction upjo, or pelviureteric junction obstruction, is defined as a blockage or obstruction of urine flow from the kidney into the. On the basis of a series of cases that were referred to the authors in their clinical practice, they found that the unprecedented quality and novel perspectives of multidetector row computed tomography ct. The blockage can be partial or complete with varying degrees of severity. How can ureteropelvic junction upj obstruction be prevented. Hydronephrosis in the course of ureteropelvic junction. However, the impact of the etiology of the obstruction on the outcome of an endopyelotomy has not been defined.
Ureteric obstruction at the ureteropelvic junction upj is the most common lesion of the fetal urinary tract, occurring in 1 in 2000 newborns. The patient was an otherwise healthy 21yearold woman who presented with symptomatic ureteropelvic junction obstruction with the duplex system, which. There does not appear to be anything one can do to prevent upj obstruction when it is a genetic condition. Pdf ureteropelvic junction obstruction upjo is characterized by impaired flow of urine from the renal pelvis to the ureter. Furthermore, robotassisted laparoscopic pyeloplasty has been accepted as the standard approach by urologic surgeons because of its superiority over conventional laparoscopy in. Mru studies were evaluated by two pediatric radiologists for the presence or absence of crossing vessels. Ureteropelvic junction obstruction upjo, or pelviureteric junction obstruction, is defined as a blockage or obstruction of urine flow from the kidney into the proximal upper ureter. This problem occurs in approximately one in 1,500 children.
Oct 07, 2014 ureteropelvic junction obstruction upjo is characterized by impaired flow of urine from the renal pelvis to the ureter. Ureteropelvic junction obstruction upjo is a common anomaly of the genitourinary tract, and laparoscopic pyeloplasty is a standard approach for patients because its longterm outcome is equivalent to open approach. Treatment of ureteropelvic junction obstruction using a. This results in decreased flow of urine down the ureter and an increase of fluid pressure inside the kidney. Ureteropelvic junction obstruction upjo, also referred to as puj obstruction, represents the most common cause of hydronephrosis in the neonate and is also a common cause of renal pelvic dilatation in children. Robotassisted laparoscopic pyeloplasty for ureteropelvic. Ureteropelvic up junction obstruction may also be called. Ureteropelvic junction obstruction investigative and clinical urology. It can be congenital or acquired with a congenital puj obstruction being one of the commonest causes of antenatal hydronephrosis. Pdf laparoscopic treatment for ureteropelvic junction. It is the most common congenital cause of obstruction blockage in the urinary tract. Hypertension is an indication for surgery in children with ureteropelvic junction obstruction. Pdf management of ureteropelvic junction obstruction in. It is generally diagnosed in the routine workup during antenatal period and is characterized by spontaneous recovery.
The clinical significance of these vessels was also evaluated. Overall, the findings appeared to be consistent with a ureteropelvic junction upj obstruction. Upj obstruction may be diagnosed before birth but it is also found in adults. Ureteropelvic junction obstruction is a blockage in the area that connects the renal pelvis part of the kidney to one of the tubes ureters that move urine to the bladder.
Ureteropelvic junction upj obstruction is by far the most common cause of pediatric hydronephrosis. The blockage slows or stops the flow of urine out of the kidney. Ureteropelvic junction upj obstruction is a blockage in the renal pelvis of the kidney. Horseshoe kidney with bilateral ureteropelvic junction. This obstruction occurs where the ureter the tube that drains the kidney inserts into the kidney. We report the case of a 15yearold boy, who is known to. Laparoscopic treatment for ureteropelvic junction obstruction. Conversely, a dilated distal ureter can be observed with ureterovesical junction. Researchers have not found any link between a mothers eating, diet or nutrition, and the formation of upj obstruction in an unborn child. Ureteropelvic junction obstruction upjo is a benign, congenital condition that remains an enigma in terms of both diagnosis and therapy. The treatment of ureteropelvic junction has evolved considerably over the past 20 years, resulting in new surgical techniques, but traditional open surgery remains the gold standard treatment. Department of renal and genitourinary surgery, hokkaido university graduate school of medicine, sapporo, hokkaido, japan.