Ureteropelvic junction obstruction

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Ureteropelvic junction (UPJ) 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 obstruction (UPJO) is defined as functional or anatomic obstruction to urine flow from the renal pelvis into the ureter at their anatomic junction. ^[1]

If left untreated, results in symptoms, renal damage, or both.

UPJO generally implies a congenital partial proximal ureteric obstruction detected in utero or in later life.

• The ureterovascular tangle is a term that embraces the renal pelvis, ureter, and adjacent vessels (both arterial and venous), all of which alone or in combination have been implicated as potential causes of UPJO.
  • The Vasculature: In the context of UPJO, “crossing vessels” are those renal arteries or veins found in the region of the ureteric transition point.
  • The Ureter: The normal ureter inserts at the inferior aspect of the renal pelvis at an oblique angle and with gradual taper. It has been noted that in the setting of UPJO, the ureter tends to have a more cephalad or acute insertion.

• Therapy: Characteristic symptoms with morphologic evidence of UPJO may indicate a need for therapy.
• Such symptoms include intermittent pain after drinking large volumes of fluid or fluids with a diuretic effect.
• Asymptomatic UPJO may be treated if there is evidence of asymmetric function or deterioration in renal function or hydronephrosis.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

UPJ obstruction generally occurs when a baby is still growing in the womb. This is called a congenital condition (present from birth). Most of the time, the blockage is caused when the connection between the ureter and the renal pelvis narrows. This causes urine to build up, damaging the kidney.

The condition can also be caused when a blood vessel is located in the wrong position over the ureter. In older children and adults, UPJ obstruction can be due to scar tissue, infection, previous treatments for a blockage, or kidney stones.

UPJ obstruction is the most frequently diagnosed cause of urinary obstruction in children. It is now commonly diagnosed during prenatal ultrasound studies. In some cases, the condition isn’t seen until after birth. Children may have an abdominal mass or a urinary tract infection

The most severe cases of UPJ obstruction may require surgery early in life. However, the majority of cases may not require surgery until later in life, and some cases do not require surgery at all.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Permanent loss of kidney function (kidney failure) is a possible complication of untreated UPJ obstruction. Even after treatment, the affected kidney may be at increased risk for infection or kidney stones.

Early diagnosis and treatment of UPJ obstruction may help preserve future kidney function. UPJ obstruction diagnosed before birth or early after birth may actually improve on its own.

Most patients do well with no long-term consequences. Significant kidney damage may occur in those who are diagnosed later in life. Current treatment options provide good long-term outcomes. Pyeloplasty provides the greatest long-term success.

In severe cases, rapidly taking pressure off the kidney (kidney decompression) immediately following birth may greatly improve kidney function.

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