Ureteropelvic Junction (UPJ) Obstruction occurs when there is a blockage at the renal pelvis of the kidney. The renal pelvis, situated at the upper end of each ureter (the tubes that carry urine from the kidneys to the bladder), collects urine. Normally, each kidney has one ureter. The kidneys filter blood, removing waste and excess water to produce urine. This urine accumulates at the Ureteropelvic Junction and then flows down the ureters into the bladder. In UPJ obstruction, the flow of urine is either slowed or completely blocked. This condition increases the risk of kidney damage. Typically, only one kidney is affected in most cases of UPJ obstruction.

How Common is UPJ Obstruction?

UPJ obstruction occurs in approximately one out of every 1,500 births and accounts for about 80% of all cases where the urine-collecting systems are swollen. Males are affected more frequently than females, with the left kidney being affected about twice as often as the right. For parents concerned about this condition in their children, consulting a Pediatric Urology Doctor in Gurgaon can provide essential insights and management options.

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Symptoms and Causes

Symptoms of Ureteropelvic Junction Obstruction:

• Abdominal lump
• Urinary tract infection accompanied by fever
• Soreness in the back or upper abdomen, commonly following hydration. This pain results from urine backup, putting pressure on the kidney and surrounding tissues. Sometimes, the pain may be intermittent if the blockage is partial, allowing urine to flow at times.
• Kidney stones
• Blood in the urine
• Vomiting
• Poor growth in infants

Causes of UPJ Obstruction:

Most cases of UPJ obstruction are present at birth, indicating that the structures of the ureter or kidney did not develop correctly during fetal growth. In some instances, there may be a genetic predisposition within families, though typically only one family member is affected. Various types of obstructions present at birth include:

• Narrow ureter opening
• Errors in the number or arrangement of muscle cells in the ureter responsible for urine propulsion
• Abnormal folds in ureter walls acting as valves
• Twists in the ureter
• High connection of the ureter to the renal pelvis, creating an abnormal angle
• Abnormal crossing of blood vessels causing pressure or distortion at the UPJ
• Less commonly, Ureteropelvic Junction obstructions may develop in adults due to kidney stones, upper urinary tract infections, surgery, abnormal blood vessel crossing, or urinary tract swelling.

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Diagnosis and Tests

Diagnosis of UPJ Obstruction:

• Pre-birth ultrasound can detect Ureteropelvic Junction obstruction by observing kidney swelling (hydronephrosis) caused by urine backup.
• Post-birth tests include blood and urine samples (such as BUN and creatinine tests) to assess kidney function.
• Imaging tests such as intravenous pyelogram (IVP), nuclear renal scan, ultrasound, CT scan, and MRI can identify kidney obstructions and evaluate kidney, ureter, and bladder structure.
• Parents who suspect UPJ obstruction in their children should consider consulting a Pediatric Urology Doctor in Gurgaon to ensure a thorough diagnosis and appropriate treatment plan.

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Management and Treatment

Treatment of UPJ Obstruction:

In many infants, Ureteropelvic Junction obstruction improves within the first 18 months of life without intervention. Regular ultrasounds and scans monitor progress to prevent lasting kidney damage. If the obstruction persists beyond 18 months and urine flow does not improve, surgery is typically required. Open pyeloplasty is commonly performed in infants, where the blockage at the UPJ is removed, and the ureter is reattached to the renal pelvis with a wider opening to promote free urine drainage and alleviate symptoms.

Minimally invasive pyeloplasty, which uses a laparoscope, involves smaller incisions and may also be used. Alternatively, a non-surgical approach involves inserting a wire through the ureter to the site of obstruction to cut it, accompanied by temporary drainage insertion for healing. Families seeking expert advice on these procedures should consult a Pediatric Urology Doctor in Gurgaon to explore the best options for their child.

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Post-Treatment Outlook:

Open pyeloplasty has a success rate of about 95%, with patients typically staying in the hospital for two to three days post-surgery. A drainage tube may be placed to assist urine flow during recovery. Minimally invasive techniques have comparable success rates but require greater surgical skill and are influenced by patient age and size.

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Prevention

There is no known dietary or nutritional link to prevent UPJ obstruction in developing fetuses. For adults not born with Ureteropelvic Junction Obstruction, avoiding kidney stones, urinary tract infections, and kidney trauma can reduce the risk of developing the condition later in life.

If you have concerns about UPJ obstruction or other pediatric urological issues, seeking guidance from a Pediatric Urology Doctor in Gurgaon can provide peace of mind and ensure that your child receives the best possible care.