Ureteropelvic Junction Obstruction
What is Ureteropelvic Junction Obstruction?
Ureteropelvic junction (UPJ) obstruction is a partial or intermittent total blockage of the flow of urine that occurs where the ureter enters the kidney. 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. The blockage seen in UPJO is thought to be caused by a congenital narrowing of the ureteropelvic junction or less commonly by compression of the ureteropelvic junction by a blood vessel to the kidney.
An obstruction can occur when:
• the ureter is too narrow
• the ureter becomes kinked
• a blood vessel passes over the ureter
Symptoms of a ureteropelvic junction obstruction
Often times a ureteropelvic junction obstruction is suspected before birth on screening ultrasound that show a kidney that is too dilated. Typically, a this obstruction will cause episodes of flank pain and nausea. In addition, children with this type of obstruction may present a urinary tract infection or a kidney stone.
Treatment for a ureteropelvic junction obstruction
A child with a partial blockage with a well functioning kidney can be often treated with just observation which involves obtaining serial ultrasound imaging in order to follow the dilation of the kidney and certainly less frequently performed lasix renal scans. Typically a large portion or percentage of children will outgrow these dilations and obstructions. However, if the x-rays worsen, or the child has developed a urinary tract infection, surgery will be needed.
The surgical procedure known as Pyeloplasty which just means ureteropelvic construction of the ureteropelvic junction is performed by making an incision on the side of the body and the narrowed part of the ureteropelvic junction is removed and the pelvis and ureter are sewn back together to make a wide channel. The surgery is very successful in getting rid of the ureteropelvic junction obstruction all together.
What happens before the surgery?
Your child will have an appointment in the Pre-op Clinic to meet with the doctors and nurses and prepare your child for the surgery. They will give you a checklist of instructions to follow the day before
your child’s surgery.
On the day of the surgery, take your child to the Surgery Unit, following the instructions given in the pre-op visit. When it is time for the surgery, your child will go to the operating room. Both parents can walk in with your child and stay until he or she is asleep. The Anesthesiologist will give your child medication to breathe in through a mask, which will help your child fall asleep. Then, he or she will put in an intravenous (I.V.) which will be used to deliver the rest of the sleeping medication (anesthesia) for the surgery. The surgery usually takes about 3 hours.
What happens after the surgery?
After the surgery, your child will go to the Post Anesthetic Care Unit (PACU) to be closely monitored until he or she is fully awake. As soon as possible, the nurse will bring you to the PACU to be with your child. When your child is fully awake, you will go to the ward where your child will stay for a few days. While in the hospital, the doctors and nurses will monitor your child, ensure that he or she is not in pain, and care for the surgical site. After surgery, your child will have a catheter which will stay in place while he or she is in the hospital. This is a small, flexible tube that goes through the urethra and into the bladder to drain urine. Most children who have a pyeloplasty will have a stent. A stent is a small, plastic tube that is placed inside the ureter to keep it open. In 4 to 6 weeks, the stent will need to be removed in the operating room