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Ureteropelvic Junction (UPJ) Obstruction

What is a UPJ Obstruction?

 

A Ureteropelvic Junction (UPJ) obstruction is a blockage where the kidney connects to the ureter, preventing urine from flowing freely into the bladder. This can lead to hydronephrosis (swelling of the kidney), pain, infections, and kidney damage. UPJ obstruction can be congenital (present at birth) or develop later in life due to scar tissue, kidney stones, or trauma.

Risk Factors

Several factors may contribute to the development of a UPJ obstruction, including:

  • Congenital Defects – Most cases are present from birth due to abnormal ureter development.
  • Kidney Stones – Stones blocking the UPJ can lead to scarring and obstruction.
  • Scar Tissue or Previous Surgery – Prior kidney or ureteral surgery can cause strictures at the UPJ.
  • Trauma or Compression – Injury to the kidney area or abnormal blood vessel placement may obstruct urine flow.
  • Urinary Tract Infections (UTIs) – Chronic infections can cause inflammation and scarring.

Symptoms

UPJ obstruction symptoms can vary depending on severity and whether one or both kidneys are affected. Common signs include:

  • Flank or abdominal pain, especially after drinking fluids.
  • Recurrent UTIs – Due to stagnant urine and bacterial growth.
  • Blood in the urine (hematuria) – A sign of kidney irritation or damage.
  • Nausea and vomiting – Often due to kidney swelling or infection.
  • Palpable mass – In some cases, an enlarged kidney may be felt.
  • High blood pressure (hypertension) – Chronic obstruction can lead to kidney dysfunction, affecting blood pressure regulation.

Treatment (Robotic & Endoscopic Surgery)

The goal of treatment is to restore urine flow, relieve symptoms, and prevent kidney damage. The approach depends on the severity of the obstruction.

Robotic Surgery (Pyeloplasty)

  • Gold standard for UPJ obstruction repair when caused by a congenital defect or scarring.
  • A minimally invasive robotic-assisted procedure to remove the narrowed section and reconnect the healthy ureter to the kidney.

Endoscopic Surgery (Minimally Invasive Option)

  • Provides long-term success with a high cure rate and faster recovery than open surgery.
  • Balloon Dilation – A balloon is inserted and inflated to widen the blocked area.
  • Endopyelotomy – A laser or scalpel makes an incision in the UPJ to open the obstruction.
  • Ureteral Stenting – A temporary stent is placed to keep the ureter open while healing.
  • Best suited for mild to moderate strictures, though recurrence rates may be higher than with robotic pyeloplasty.

Prevention

While congenital UPJ obstruction cannot be prevented, certain measures may help reduce the risk of acquired obstructions:

  • Stay Hydrated – Drinking plenty of water helps flush out kidney stones and prevent infections.
  • Manage Kidney Stones Promptly – Early treatment of stones can prevent blockages and scarring.
  • Prevent UTIs – Seek early treatment for urinary infections to avoid inflammation and damage.
  • Protect Kidney Health – Maintain a healthy lifestyle and avoid trauma to the kidney area.

UPJ obstruction is highly treatable, and early intervention can prevent long-term kidney damage. If you experience flank pain, recurrent infections, or difficulty urinating, consult a urology specialist for evaluation and treatment options.