UPJO - Ureteropelvic Junction Obstruction

The most common congenital anomaly in the upper urinary tract is the dilation of the renal pelvis. Typically, the diagnosis of renal pelvic dilation is made after identifying an enlarged renal pelvis during ultrasound examination during pregnancy. One of the functions of the kidney is to filter various waste products from the blood and excrete them with urine into the urinary bladder. After filtration, urine enters the renal pelvis, passes through a tube called the ureteric pelvis, and continues downward into the urinary bladder. Anomalies or blockages in the renal pelvic outlet can lead to the dilation of the renal pelvis and eventually disrupt kidney function.

The degree of renal pelvic dilation ranges from mild cases that only require monitoring without treatment, to moderate and severe cases that necessitate surgical correction to rescue the obstructed kidney and prevent complications like urinary tract infections and high blood pressure.

Symptoms of the condition and diagnostic methods

The majority of diagnosed cases of renal pelvic dilation occur after identifying an enlarged renal pelvis during pregnancy. Close monitoring is recommended following such diagnosis, to track changes in the extent of renal pelvic enlargement, monitor urine output, and monitor renal pelvis size. In most cases there is no need for premature delivery.

Diagnosis

When a fetus is diagnosed with renal pelvic dilation, ultrasound examination is usually performed shortly after birth. Between one and two months of age, a follow-up examination is conducted to assess whether there is still renal pelvic enlargement and to examine the dynamics of the dilation. However, ultrasound examination can only confirm the presence of renal pelvic enlargement, and additional tests might be required to assess whether there is a blockage and the risk of kidney function deterioration.

Treatment

Less than 50% of diagnosed cases necessitate surgical treatment. Surgical correction is recommended where -

- there is a decline in kidney function during follow-up, or where kidney function remains low after birth.
- significant blockage is detected during kidney mapping, or clinical symptoms like urinary tract infections or flank pain are present.

Where surgery is required, it is performed using minimally invasive robotic-assisted techniques. The procedure involves small incisions and often includes the placement of an internal stent that is usually removed after about 6 weeks (under anesthetic or sedation).

Follow-Up

After surgery, follow-up ultrasounds and mapping tests are conducted at specific intervals to monitor kidney function improvement. Regular assessments are made based on the results of these tests, and further examinations are scheduled accordingly.