Ureteropelvic Junction Obstruction (UPJ)

What is it?

Pelvic-ureteral joint stenosis is a set of conditions that result in a narrowing of the point of passage between the renal pelvis and ureter, obstructing the normal flow of urine. This narrowing causes dilation of the pelvis and stasis of urine in the pelvis itself, promoting the onset of various complications, from infections to kidney failure, severity of which is related to the extent of the narrowing. Ureteral pyelojunction syndrome is a congenital condition. In 80% of cases, it is due to an intrinsic narrowing of the joint, while in the remaining 20% of patients, it is due to compression by external elements, such as abnormalities of blood vessels or a high, therefore abnormal, insertion of the ureter. Although it is a congenital pathology, it can also occur in adulthood, but it can be diagnosed incidentally.

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.

Where do we treat it?

Within the San Donato Group, you can find Ureteropelvic Junction Obstruction (UPJ) specialists at these departments:

Are you interested in receiving the treatment?

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