Symptoms and conditions also mentioned with hydronephrosis in patients discussions. This image demonstrates severe hydronephrosis of the right kidney. It is now commonly diagnosed during prenatal ultrasound studies that show a dilated renal pelvis or a condition called hydronephrosis. Symptoms may include an abdominal mass or a urinary tract infection. Comparison between diuretic urography ivp and diuretic. For classification see section ureter ultrasonography. Most of the time, surgery is not needed until later. Upj obstruction is the most frequently diagnosed cause of urinary obstruction in children. 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 see figure 1. In the ivp, feps can appear to be long, smooth ureteral filling defects with various degrees of hydronephrosis. The lower pole of a duplex kidney is most commonly affected because the segment in the upper pole lacks a true pelvis. Pain medications are given to alleviate pain and discomfort because it is expected that the ureter is swollen for a few days. The incidence of upj obstruction is less well defined in adults than in children.
In addition, it is important to obtain a pyelogram during the paroxysm of colic to diagnose a upj obstruction. This can be due to a number of conditions, including congenital abnormalities of the ureter muscles, unusually located blood vessels that block the path of the ureter, or scarring from previous. A specific type of kidney obstruction that is seen not uncommonly in the adult population, and is common in the pediatric population, is called a ureteropelvic junction obstruction, or upj obstruction. Upj obstruction may cause blockage of urine drainage.
Upj obstruction is less common in adults than in children but is not rare in either population. A upj obstruction can also occur if a blood vessel is positioned incorrectly over the ureter. Ureteral obstruction diagnosis and treatment mayo clinic. Ureteropelvic junction upj obstruction occurs when the area connecting the renal pelvis part of the kidney to one of two tubes that connect with the bladder ureter becomes blocked, causing urine to build up, which damages the kidneys. This is where the kidney attaches to one of the ureters the tubes that carry urine to the bladder. Scheduled clinic visits to check the status of the patient and the postoperative site. Dilatation of the renal pelvis and caliceal system with a stenotic ureteropelvic segment. Ucsf department of urology ureteropelvic junction obstruction. Hydronephrosis means literally water inside the kidney and refers to the distension and dilation of the pyelocaliceal system. Hydronephrosis and ureteropelvic junction obstruction treato found 14 discussions about ureteropelvic junction obstruction and hydronephrosis on the web.
Ureteropelvic junction obstruction penn state hershey medical. Ranked as the best urology hospital in india, psri treats various diseases of the urinary tract like. Intravenous pyelography ivp has historically been the primary study used to diagnose upj obstruction in adults, because it also provides. Feb 23, 2016 urinary obstruction is a common cause of acute and chronic renal failure. Ivp findings suggestive of ureteropelvic junction obstruction include marked dilatation of the renal calyces and pelvis, funneling down to a narrow beak end, with nonvisualization of the ipsilateral ureter see the images below. Ultimately, a ct scan performed during an acute pain crisis clearly. Pelviureteric junction obstruction radiology reference article. Bwh mru kidney focus sag, cor, ax single shot haste or ssfse kidney sag, cor, ax t2w fse kidney ax t1 dual echo inout of phase kidney ax dwi 0250500 or 0500 kidney cor single shot fse fs 20mm bh ureters inject 10 mg iv furosemide or 250 cc ns at start ax 3d gre lava or vibe fs pre kidney inj cm, then ax 3d gre fs post x3 kidney. Causes the diagnosis of ureteropelvic junction obstruction also known as upj obstruction implies there is blockage of urinary flow from the kidney down into the ureter. In the pediatric age group, it is the most common cause of upper urinary tract dilation, accounting for 80% of all dilated collecting systems identified antenatally by fetal ultrasonography. In this disorder, the patients kidneys fuse together to form a horseshoeshape during development in the womb.
Ureteropelvic junction obstruction upjo is a congenital resistance to the transport of urine from the. Congenital malformations with obstruction of the ureteropelvic junction are a common cause for hydronephrosis fig. Ureteropelvic junction obstruction ucsf department of. Hydronephrosis and upper urinary tract obstruction. Tony nimeh is proud to be among the few urologists in alaska to offer expertise in da vinci. Ureteropelvic junction upj obstruction cedarssinai. I decided this week to check out these message boards to see if i could find an adult female who shares the experience i have had. In some cases, the condition may not show up until after birth. The tube that carries the urine from the renal pelvis into the bladder is called the ureter. Imaging in congenital ureteropelvic junction obstruction.
Ureteropelvic junction obstruction upjo is characterized by impaired flow of urine from the renal pelvis to the ureter. The kelaliskingbelman textbook of clinical pediatric urology. Upj obstruction generally occurs when a baby is still growing in the womb. Magnetic resonance imaging mri it can be used to diagnose upj type hydronephrosis. The blockage may be severe high grade, minimal low grade or intermittent. Surgery may be needed early in life if the problem is severe. Upj obstruction is the most common cause of urinary blockages in children. The frequent use of fetal ultrasound is allowing early prenatal diagnosis of numerous uropathies. Hydronephrosis and upper urinary tract obstruction definition of hydronephrosis. Surgical management of ureteropelvic junction obstruction. A blockage in the upj can inhibit the flow of urine. Upj obstruction definition ureteropelvic junction upj obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder ureters.
Not uncommonly, asymptomatic upj obstruction is discovered in older children or adults when radiologic studies, such as ultrasonography, intravenous pyelography ivp, computed tomography ct scanning, or magnetic resonance imaging mri. Herein we present a 25yearold female with several years of intermittent flank pain and abdominal symptoms with prior inconclusive diagnostic workup including abdominal imaging without hydronephrosis. Pelviureteric junction puj obstruction stenosis, also known as ureteropelvic junction upj obstruction stenosis, can be one of the causes of an obstructive uropathy. It is now commonly found before birth with ultrasound tests. If a usg suggests the presence of upj obstruction or other ureteral problems, ivp may be indicated. A ureteropelvic junction obstruction upjo is a congenital narrowing or obstruction where the ureter meets the kidney.
Symptoms and signs of obstruction are often mild, occurring over long periods of time and requiring a high index of suspicion for diagnosis. The narrow area where these two structures meet is called the ureteropelvic junction upj. Ureteropelvic junction obstruction upjo is one of the most common causes of urinary tract. Ureteropelvic junction upj obstruction is a condition where the ureter, the tube that connects the kidney to the bladder, is blocked at the top portion where it leaves the kidney. Ivpivu has been performed for assessing for puj obstruction.
Hydronephrosis that occurs acutely with sudden onset as caused by a kidney stone can cause intense pain in the flank area between the hips and ribs. Upj obstruction is the most common pathologic cause of antenatally detected hydronephrosis. Horseshoe kidney, also known as ren arcuatus in latin, renal fusion or super kidney, is a congenital disorder affecting about 1 in 500 people that is more common in men, often asymptomatic, and usually diagnosed incidentally. Ureteropelvic junction obstruction an overview sciencedirect. A percentage of ureteropelvic junction obstruction cases are clinically silent in childhood and manifest symptoms in adults. Thus, upj obstruction must be considered in the differential diagnosis for intermittent flank or abdominal pain in the adult. Hydronephrosis is caused by an obstruction of the urine flow from the kidney. The intravenous pyelogram ivp revealed hydronephrosis and a dilated renal pelvis that had corkscrew narrowing on the left side. In others, however, the restriction to urine flow across the upj will cause progressive renal deterioration15,16,62,63.
When recognized before the baby is born, upj obstruction may require surgical correction in the first few days after birth. Pdf uretero pelvic junction obstruction in the newborn. Ureteropelvic junction upj obstruction is a partial or intermittent total blockage of the ow of urine that occurs where the ureter enters the kidney. This operation, called a pyeloplasty, allows rapid and easy drainage of urine produced by the kidney and relieves symptoms and the risk of infection. This may involve periodic blood and urine tests, ultrasound and nuclear renal scans until it is clear that the problem has been corrected. The signs and symptoms of hydronephrosis depend upon whether the obstruction is acute or chronic, partial or complete, unilateral or bilateral. The urine is then drained from the kidneys through a funnelshaped structure called the renal pelvis into a.
This narrowing will not allow urine to drain from the kidney. Retrograde pyelography demonstrates an obstruction at the upj. Congenital ureteropelvic junction upj obstruction is a well recognized pathology. 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. The blockage slows or stops the flow of urine out of the kidney. Surgical management of ureteropelvic junction obstruction in. Treatment of adult upj obstruction has evolved over time. Ureteral obstruction surgery may be performed through one of these surgical approaches. A nissen fundoplication is the surgery to correct gerd aka acid reflux. Upj obstruction the renal pelvis is the structure that drains urine from the kidneys. Pelviureteric junction puj obstructionstenosis, also known as ureteropelvic junction upj.
Ureteropelvic junction obstruction johns hopkins medicine. I have had a ureteral stent in place for approximately four months. To be honest with you, the surgery probably saved my kidney from further damage, but i developed other kidney. Ureteropelvic junction obstruction cincinnati childrens. Ivp and diuretic renography for diagnosis of ureteropelvic. The advantage of mri is the ability to discern accurate anatomy defining the point of obstruction. Upj obstruction is the cause of most urinary blockages in children. Management of ureteropelvic junction obstruction in adults. It typically occurs due to the presence of an aperistaltic segment of the ureter, very frequently aggravated by. It often happens when a baby is still growing in the womb. The surgeon makes a cut into the damaged or blocked part of the ureter to widen the area and. Upj obstruction does not represent a single anatomic entity, but rather a group of obstructive processes that result from multiple etiologic factors. Ureteropelvic junction obstruction followup after upj obstruction is treated, followup can ensure that the affected kidney is functioning properly. Endoscopic surgery, a minimally invasive procedure, which involves passing a lighted scope through the urethra into the bladder and other parts of the urinary tract.
Robotic pyeloplasty for upj obstruction fairbanks urology. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. I had a upj obstruction in my only kidney from birth for 9 years before i found a doctor at cleveland clinic that was experienced in upj laser surgery. Where this was once a major procedure with an incision from the front to back under the ribs, we replace this with four tiny incisions the width of your thumb. It typically occurs due to the presence of an aperistaltic segment of the. A combination of ct imaging and diuretic renography is. Ureteropelvic junction upj obstruction is when part of the kidney is blocked. The majority of infants with antenatally detected renal pelvic dilatation improve spontaneously. The standard treatment of ureteropelvic junction obstruction upjo is represented. Hydronephrosis and ureteropelvic junction obstruction.
Ureteropelvic junction upj obstruction is defined as an obstruction of the flow of urine from the renal pelvis to the proximal ureter. Typically, when imaging studies reveal an incomplete obstruction, the patient is monitored with routine renal ultrasonography and nuclear medicine renography. As discussed above, hydronephrosis does not equate with obstruction. I have a wonderful supportive family, especially my husband and sister. Upj obstruction is found in approximately 50% of patients diagnosed with antenatal hydronephrosis.
Ureteropelvic junction obstruction in adults sciencedirect. Jul 28, 2009 the content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Dec 31, 20 in upj obstruction, the ct scan typically shows hydronephrosis without a dilated ureter. A wide variety of pathological processes, intrinsic and extrinsic to the urinary system, can cause obstruction. In children with ureteropelvic junction upj obstruction, medical therapy is focused on maintaining sterile urine and assessing renal function and the degree of hydronephrosis.
In general, the le kidney is more commonly a ected than the right kidney. In some children there can be a partial blockage at the upj. Ureteropelvic junction upj obstruction may be defined as a functional or anatomic obstruction to urine flow from the renal pelvis to the proximal ureter that results in symptoms or renal damage. Best urology hospital in delhi kidney stone surgery. This provided a 98% success rate, but a very long six week recovery and considerable pain. Delayed recognition of an ureteropelvic junction obstruction.
Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography us, intravenous pyelogram ivp, diuretic renography dr, magnetic resonance urography mru and antegrade or retrograde pyelography. Historically, this type of pain has been described as. Ureteropelvic junction upj obstruction is a blockage at the point. This is called a congenital condition present from birth. A ureteropelvic junction obstruction upjo is a blockage of urine flow from the renal pelvis to the ureter. Untreated disease can result in renal impairment making effective management crucial. Dec 20, 2015 not uncommonly, asymptomatic upj obstruction is discovered in older children or adults when radiologic studies, such as ultrasonography, intravenous pyelography ivp, computed tomography ct scanning, or magnetic resonance imaging mri, are performed for other reasons. In upj obstruction, the ct scan typically shows hydronephrosis without a dilated ureter. The urinary tract includes kidney, ureter, bladder and prostate in men. Pelviureteric junction obstruction radiology reference.
Kidney adult congenital upj obstruction healthboards. In the meantime, my urologist has suggested that i undergo a nephrostomy in order that the stent can be removed for one week prior to surgery. The urine leaves the kidney, enters the renal pelvis, and then passes into the ureter through a funnel called the ureteropelvic junction upj. A pyelogram or renogram will show a small nonobstructed upper segment. Ureteropelvic junction upj obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder ureters. The condition is frequently encountered by both adult and pediatric urologists. However, the detection rates of feps through ivp vary from 36% to 100% according to current literature.
Urology is a surgical specialty which deals with diseases of the urinaryreproductive tracts in men and with urinary disease in women. This can be due to a number of conditions, including congenital abnormalities of the ureter muscles, unusually located blood vessels that block the path of the. A rare cause of ureteropelvic junction obstruction ncbi. A combination of ct imaging and diuretic renography is typically used for diagnosis. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. We will not spend too much time here discussing the problem of pediatric upj obstruction other than to. Upj obstruction laparoscopic pyeloplasty our kidneys produce urine by filtering and purifying the blood and completely eliminating wastes, salts and water. Puj obstruction or upj obstruction medical treatment centre. The ureteropelvic junction upj is the junction between the proximal ureter and renal pelvis. It generally occurs when a baby is still growing in the womb. The urethra seldom has obstruction related to stones.
The classic treatment of upj obstruction is an open operation to remove the upj and to reattach the ureter to the pelvis of the kidney creating a wide junction between the two. Stones in the bladder do not cause obstruction or symptoms unless they are staghorn stones. The urine is then drained from the kidneys through a funnelshaped structure called the renal pelvis into a natural tube called the ureter. Differential diagnosis of hydronephrosis urinary retention. Ureteropelvic junction upj obstruction overview, symptoms. Uretero pelvic junction upj obstruction is a common cause of hydronephrosis in infants. It can be congenital or acquired with a congenital puj obstruction being one of the commonest causes of antenatal hydronephrosis. Comparison between diuretic urography ivp and diuretic renography for. With a stone in the kidney or at the ureteropelvic junction upj, the pain may be dull costovertebral flank pain. Ive had stomach issues for years and one of my many tests ordered by my gastro doc was an abdominal ct scan.
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