How is ureteropelvic junction obstruction treated?
In many infants with UPJ obstruction, the condition may improve on its own within the first 18 months of life. During this time, repeated ultrasounds and scans are used to monitor the condition to make sure it will not cause lasting harm.
If urine flow does not improve and the obstruction remains after the first 18 months of life, surgery is usually needed to fix the problem. In infants, the surgery most often used is called open pyeloplasty. In this procedure the UPJ is removed, and the ureter is reattached to the renal pelvis but with a wider opening. The goal of the surgery is to allow urine to drain freely, to eliminate symptoms, and to reduce the chances of infection.
Minimally invasive pyeloplasty uses a laparoscope, a long thin tube requiring just a small incision through which the surgeon or a robot operates surgical tools.
Another option is to insert a wire through the ureter to reach the site of the UPJ obstruction internally. The wire is then used to cut the obstruction and a drain is inserted for a few weeks during healing. This procedure involves less discomfort than the other two options but also has a lower rate of success and may have to be repeated more than once.
What can be expected after treatment for ureteropelvic junction obstruction?
Open pyeloplasty usually takes a few hours to complete and has about a 95% success rate. The patient may need to stay in the hospital for two or three days following surgery. A drainage tube may be inserted into the kidney or ureter to assist in urine flow while healing takes place.
The success rate of minimally invasive techniques is on par with open pyeloplasty but is more technically demanding of the skills of the surgeon and is dependent on patient age and size.