What is UPJ Obstruction in Children?

UPJ obstruction is an obstruction in the renal pelvis of the kidney. This is the renal pelvis, located on the upper end of every ureter, a tube that drains urine from the kidneys to the bladder, which is funnel-shaped with urine collection.

In normal cases, only one ureter is attached to a pair of kidneys. The kidneys filter all that is unused and excess waste matter through the blood to create urine. The urine is pooled at the UPJ and then flows by gravity down the ureters to the bladder.

The urine flow can be slowed down or completely blocked in UPJ obstruction. This increases the likelihood of kidney damage. In most cases of UPJ obstruction, only one kidney is affected.

What are the symptoms of ureteropelvic junction obstruction?

There may be no symptoms. If they are present, symptoms include the following:

• Back or flank pain
• Bloody urine (hematuria)
• Lump in the abdomen (abdominal mass)
• Kidney infection
• Poor growth in infants (failure to thrive)
• Urinary tract infection, usually with fever
• Vomiting

What causes ureteropelvic junction (UPJ) obstruction?

Precise cause of UPJ obstructions is not defined, but they are mostly congenital, which makes them appear during routine ultrasound in pregnancy, which indicate that they result from anomalies in fetal development of your child urinary tract.

There is couple of ways an obstruction occurs while your baby is formed:

• A portion of your child's ureter does not develop completely. The piece can therefore be quite thin and more likely to become obstructed.
• There could be an area missing in the muscle layer of the ureter.
• Your child may have what is referred to as a "crossing vessel". That is, there is an extra artery that goes to the kidney. In this case, the extra artery can cause kinking or obstruction of the ureter.
• This disorder is known to be congenital, meaning it occurs at birth, and to run in families, therefore implying a genetic basis though the responsible genes have yet not been identified.

How do physicians diagnose ureteropelvic (UPJ) junction obstruction before and after birth?

An ultrasound of the fetus before birth may demonstrate a UPJ obstruction. Because urine cannot get around the blockage, urine accumulation causes the kidney to become enlarged beyond its usual size, a condition referred to as hydronephrosis.

Post-natal tests that measure the urine production and drainage that may be conducted include:

• Dilution tests, whereby blood samples and urine samples like BUN and Creatinine tests give an approximate idea of how well kidneys are filtering the blood into the urine.
• An Intravenous Pyelogram uses a dye injected into the bloodstream, which is detected later by X-ray coming through the kidney, to the renal pelvis as well as the ureter.
• A nuclear renal scan uses a radioactive substance rather than a dye and can be traced with a special camera. This reveals how the kidney is functioning and the amount of obstruction present.
• Ultrasound, CT, and MRI scans show obstructions in the kidney as well as the anatomy of the kidneys, ureters, and bladder.
• Many infants with UPJ obstruction will improve spontaneously by 18 months of age. Repeated ultrasounds and scans are done to monitor the condition and make sure it does not result in permanent damage.

When the urine flow does not improve and the obstruction continues after the first 18 months of life, surgical intervention is often required to correct the problem. The most common pyeloplasty in an infant is an open surgery. In the procedure UPJ is excised or removed, and the surgeon reattaches the ureter to the renal pelvis but now with wider opening. Thus, all these aim to make urinary drainage free so that its symptoms are completely eradicated and opportunities for infection decreased.

Minimally invasive pyeloplasty involves the use of a laparoscope, a long, thin tube that requires only a small incision through which the surgeon or a robot operates the surgical tools.

The other alternative is inserting a wire inside the ureter to access the site of UPJ obstruction from the inside. The wire cuts the obstruction, and a drain is left for a few weeks to allow healing. This procedure doesn't require any incision, is less painful compared to the other two, but has a lower success rate and may have to be repeated more than once.

Is there a complication of UPJ obstructions?

A UPJ obstruction that is caught early can be treated relatively easily. But, if left untreated or misdiagnosed, the chronic backup of urine into the kidney can cause permanent damage to your child's kidneys and urinary system. That is why an accurate, timely diagnosis is made by seeing a specialist in urology.

Can UPJ obstruction be prevented?

No direct relationship exists between diet and nutrition during a pregnant individual and the appearance of UPJ obstruction in the fetus. There is nothing found to be effective at preventing UPJ obstruction if the condition is truly genetic in nature.

Prevention

If not innate, it would then seem that not developing kidney stones, a urinary tract infection or renal trauma would all decrease a patient's chance to have developed UPJ obstruction in their adulthood.

What is my child's long-term outlook?

Each child is unique, and your child's long-term health depends upon her exact condition. However, the bottom line is that with an accurate diagnosis, appropriate treatment and close management of your child's treatment and care, your child should go on to achieve normal urinary function.

Why Choose Tender Palm Super Speciality Hospital for UPJ Obstruction treatment in Children in Lucknow, India?

Tender Palm Super-Speciality Hospital has the most trusted team of Pediatric Urologists with advanced diagnostic equipment and child-friendly care for Pediatric UPJ Obstruction treatment in Lucknow, India. Our Pediatric Urology department follows international safety standards and has years of experience in successfully managing children's Urological diseases.

To Seek an Expert Consultation for UPJ Obstruction treatment in Children in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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