Ureteropelvic Junction Obstruction

Ureteropelvic Junction (UPJ) obstruction is a blockage at the junction where the ureter attaches to the kidney. This causes a decreased flow of urine through the ureter and an increase in fluid pressure inside the kidney. UPJ obstruction may be diagnosed before birth but it is also found in adults. Excess urine builds up within the kidney — called hydronephrosis — and may be seen on an ultrasound. Scar tissue, kidney stones, previous surgery or disorders of the upper urinary tract can also lead to UPJ obstruction.

Symptoms of UPJ Obstruction

Thanks to prenatal ultrasound screenings, many UPJ obstructions are identified before birth. Children and adults may not present with any symptoms at all. When they do, they might include:

• Abdominal mass
• Urinary tract infection with fever
• Kidney infection
• Back or flank pain
• Kidney Stones
• Bloody urine
• Vomiting

Diagnosis of UPJ Obstruction

An ultrasound is a useful screening test to detect problems in an unborn baby. After birth and for older children and adults, the following diagnostic procedures and tests may be done:

• Medical and physical examination
• Laboratory tests: BUN, creatinine clearance, electrolytes
• CT-scan, an imaging study of the kidney, ureters and bladder with contrast dye to find abnormalities or obstructions, and to assess renal blood flow.
• Magnetic resonance imaging (MRI)uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body
• Ultrasound, a diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs.
• Lasix renal scan, a nuclear medicine test that provides images of the kidneys to look for kidney function, size, shape, position and blockage of urinary flow.

Treatment for UPJ Obstruction

UPJ obstruction diagnosed before or after birth may improve on its own. If this does not happen, surgery is often recommended for children and for adults diagnosed later in life. Your urologists will discuss treatment options with you. They may include:

• Robotic pyeloplasty, a minimally invasive technique that results in reduced hospital stays, quicker return to activities, less pain, and better cosmetic outcome. The operation involves cutting out the diseased portion of the UPJ and reconnecting the two healthy ends, enabling urine to drain freely from the kidney to the bladder.
• Endopyelotomy, a minimally invasive option that places a camera through the bladder and up the ureter where the UPJ is visualized and cut, often with a laser.

What You Should Expect

You will receive a thorough diagnostic evaluation and receive clinically-proven treatment by a board-certified urologist who specializes in UPJ obstruction. Our goal is to alleviate symptoms so you can return to every life. Appointments are confidential and private.

Multidisciplinary Care

Brigham and Women’s Hospital practices a multidisciplinary approach to patient care, routinely collaborating with colleagues in other medical specialties. If your urologist discovers that an underlying illness has contributed to your UPJ obstruction, you will be referred to an appropriate BWH physician for an evaluation.

Resources

Go to our online health library to learn more about urology diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.