Understanding Ureteropelvic Junction Obstruction in Children: A Short Q&A

What is Ureteropelvic Junction Obstruction?

Ureteropelvic Junction Obstruction (UPJO) is a condition where there's 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. This blockage can occur when a baby is still growing in the womb, making it a congenital condition.

How frequently does UPJO occur in children?

UPJO is not very common, occurring in approximately 1 out of every 1,500 to 2,000 babies. It is more often diagnosed in males and can be identified prenatally or after birth.

What causes UPJO in children?

The exact cause of UPJO is not known, but it often arises from problems in the development of a child’s urinary tract. It can be due to a portion of the ureter not fully developing, leading to a narrow section, or a blood vessel crossing over the ureter and causing constriction. In infants, the most common cause of UPJ obstruction is an intrinsic narrowing of the UPJ. In older children and adolescents, the most common cause is extrinsic compression from a crossing lower pole vessel.

What diagnostic tests are used for UPJO?

Diagnostic tests for UPJO may include a prenatal ultrasound, voiding cystourethrogram (VCUG), mercaptoacetyltriglycine renal scan (Lasix renal scan), and magnetic resonance urography (MRU).

What are the treatment options for UPJO?

Treatment for UPJO can vary. In many cases, the condition may improve on its own, especially if diagnosed prenatally or just after birth. Monitoring with ultrasound exams is common. If the blockage worsens or the child experiences repeated infections or the affected kidney is deteriorating surgical intervention may be necessary.

What type of surgery is performed?

The surgical procedure commonly performed to correct UPJO is called pyeloplasty. This involves removing the area of obstruction and reattaching the ureter to the kidney to create a wide opening for urine to drain. Nowadays it is mostly done by laparoscopic surgery even in small babies.

What is the prognosis for children with UPJO?

Many children with UPJO do well with no long-term consequences if the condition is diagnosed early and managed appropriately. However, significant kidney damage can occur if the diagnosis is delayed. With current treatment options, most patients have good long-term outcomes.