Ureteropelvic Junction Obstruction (UPJ)

What is it?

La estenosis de la unión ureteropélvica es un conjunto de afecciones que provocan un estrechamiento del punto de paso entre la pelvis renal y el uréter, obstruyendo el flujo normal de orina. Este estrechamiento provoca la dilatación de la pelvis y la estasis de la orina en la pelvis, lo que da lugar a diversas complicaciones, desde la infección hasta la insuficiencia renal, cuya gravedad está relacionada con la extensión del estrechamiento. El síndrome de la articulación ureteropélvica es una afección congénita. En el 80% de los casos se debe a un estrechamiento intrínseco de la articulación, mientras que en el 20% restante de los pacientes se debe a la compresión por elementos externos, por ejemplo, vasos sanguíneos anormales o una inserción alta, y por tanto anormal, del uréter. Aunque es una afección congénita, también puede darse en la edad adulta, pero puede diagnosticarse de forma bastante incidental.

Which are the symptoms?

Symptoms are primarily related to complications of such narrowing. The most frequent are urinary tract infections, abdominal pain usually exacerbated by increased fluid intake, and hypertension related to loss of renal parenchyma.

  • urinary tract infections
  • abdominal pain
  • high blood pressure

How is it diagnosed?

Prenatal ultrasonography allows early identification of a possible syndrome of the pyelo-ureteral joint. Even in young adults, ultrasound of the urinary tract performed for the presence of classic symptoms or for other reasons is the first-line diagnostic method. In case of identification of a dilatation of the renal pelvis, one or more of the following diagnostic tests are performed to assess the severity of the problem: CT abdomen with contrast medium with possible Urographic / MRI poses: typically the involved kidney shows dilatation of the excretory tract and marked delay of the excretory phase, in the absence of ureteral dilatation; sequential renal scintigraphy: allows the study of renal function and the assessment of the presence of an obstruction to urine outflow; micturition cystography: allows the assessment of the presence of an associated vesicoureteral reflux

Suggested exams

How is it treated?

There are no drugs that can treat stenosis of the ureteral pyelojunction. The only possible treatment is surgery aimed at eliminating the narrowing in order to restore proper urine flow. The procedure is called pyeloplasty and can be performed using either open method or laparoscopic or robotic surgery. After removal of the stenotic ureter tract, the renal pelvis and ureter are reshaped to remove the stenotic segment and create a wide passage for urine. This technique is effective in more than 95% of cases, without the need for any additional treatment. The intervention is always performed under general anesthesia. If an abnormal vessel compressing the joint is present, ureter section and plastics are performed, and the vessel is positioned behind the pelvis. At the end of the plastic surgery, a ureteral brace (double J stent) is inserted for protection, which will be removed (outpatiently) after a few weeks. Lo stent ureterale interno viene rimosso 4-6 settimane dopo l’intervento. In addition to accelerating the healing process, the use of stents reduces the incidence of urinary overflow at the site of surgical repair and secondary fibrosis (exuberant scarring). The laparoscopic or robotic approach reproduces the same procedures performed by open method, with the same results.

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