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Ureteropelvic Junction Pyeloplasty

By Philip E. Gleason, MD

Ureteropelvic junction (UPJ) stenosis and obstruction is the most common cause of kidney blockage or obstruction in children. It is typically a narrowing of the ureter at the junction between the ureter and renal pelvis of the kidney. It produces blockage of urine drainage from the kidney similar to the waist in an hourglass. As such, it produces increased backpressure on the kidney and can cause impaired kidney function and ultimately long term potential damage to the kidney itself. UPJ obstruction repair, or dismembered Pyeloplasty as it is called, is surgical procedure to correct the obstruction. If the obstruction is diagnosed during pregnancy or in the early newborn period, if possible, we typically try to wait until the child is approximately 3 months of age to perform the surgery. This allows the child to grow and develop and mature to minimize any risk of anesthetic complications. After 3 months of age, the anesthetic risk (which is indeed slightly higher in the early newborn period) has dropped and will remain minimal throughout the remainder of the child's life until older adult age. Conversely, surgical correction at that time still allows the kidney to recover from the blockage and ultimately grow and develop normally during the important first years of life and then into adulthood. If we diagnose UPJ obstruction in older children, we can usually go ahead with the correction as soon as practical.

Typically the child comes to the hospital in the morning. The surgery takes approximately 2-3 hours. They do have a general anesthetic. We usually first look into the bladder and shoot an x-ray backwards from the bladder up toward the kidney to double check the ureter and make sure we know the exact location of the blockage. We usually then place the child on their side and make an incision just below the ribs on the affected side so that we can locate and work on the kidney. The narrowed, obstructed segment is completely removed and the ureter and renal pelvis are then sewn back together to re-establish drainage of the kidney to the ureter and bladder. Occasionally, although not very often, we sometimes leave a small plastic tube caked a ureteral stent from the kidney to the bladder through the ureter to allow the repair to heal. Most of the time this is not required but depends upon the size of the ureter. The skin is closed with stitches that will ultimately dissolve and disappear on their own. We usually keep the child in the hospital overnight following the surgery. About half the children are actually ready to go home the next day. The remainder stay in the hospital 2-3 days. Fortunately, children typically bounce back from the surgery very well and after the third day or so, it is oftentimes difficult to tell they had surgery at all. Occasionally they will still be a bit of a couch potato for a few more days once they are home, but usually they are rapidly back to routine activities.

We oftentimes make sure the child has done well with their surgery and their incision is healing well approximately 2 weeks afterwards. We then let the kidney heal up for approximately 3 months at which time we check another x-ray of the kidney to make sure the repair has been successful and relieved the blockage of that kidney. Fortunately, the surgery itself is highly successful (approximately 95-98%). Occasionally the surgery will fail or the blockage will recur in the future, but fortunately this is rare.

I hope this provides some introductory information regarding UPJ pyeloplasty, its techniques, and its risks and benefits. If we can provide any further information or answer any questions, please let us know