Upj narrowness

Ureteropelvic obstruction (obstruction); It is defined as a decrease in urine flow from the renal pelvis (kidney bowl) to the ureter. If left uncorrected, it leads to progressive kidney damage.

It can be seen in all age groups. Most of them are diagnosed in the perinetal (in the womb) period. It is more common in men, with a ratio of 2:1, it is more dominant on the left side, and it is seen in the left kidney with a rate of 67%.

Causes of occurrence

1- Causes arising from the wall of the urinary pipe: pause in the development of the muscles forming the pipe and changes in the collagen fiber structure
2- Causes arising from outside the urinary tract; external narrowing on the way as a result of the pressure of an abnormally developing vessel
These two reasons can be either alone or together, the main reason is due to the first one.
Signs/Symptoms
It does not cause complaints in newborns, it gives symptoms in children, and sometimes it can complain at older ages.
Growth retardation, feeding difficulties, urinary system infection, sepsis, kidney stones, pain, bleeding in the urine may be seen. In older children, episodic pain and related nausea and vomiting may occur.

Diagnosis:

Diagnosis can be made by detecting swelling in the kidney in ultrasound follow-ups performed in the womb. Ultrasound should be performed on the 3rd day after birth.
Although it is frequently used in follow-up, ultrasonography alone is not diagnostic in the diagnosis of UPJ stenosis. In ultrasonography, only enlargement of the pool in the kidney, that is, hydronephrosis, and the structure and thickness of the kidney parenchyma tissue are displayed. The anterior posterior diameter of the pelvis is measured, but this neither makes the diagnosis of obstruction nor indicates worsening and improvement.

For definitive diagnosis, a method in which the flow of urine from the kidney to the urinary canal is evaluated functionally should be used. One of these classical evaluations is intravenous pyelography (medicated kidney film) called IVP. Here, an enlarged kidney pool is seen due to the inability to adequately remove urine from the pelvis.

In IVP, the dyestuff shown by the x-rays is injected into the vein and this substance is filtered through the kidney. With serial films taken during the urinary excretion of this substance, kidney function, kidney collection systems, drug transfer to the ureter and bladder are evaluated.

Even if UPJ stenosis is demonstrated in IVP, DTPA scintigraphy with diuretic (renogram with diuretic) should be performed for definitive diagnosis. This is important not only for the definitive diagnosis, but also for the follow-up of postoperative recovery. While the radioactive material given intravenously is filtered from the kidney with a diuretic renogram, the function and drainage of the two kidneys are measured and evaluated separately. This assessment yields a drainage curve for both the right and left kidney. The curve with UPJ stenosis does not empty and has an increasing curve. This ascending curve should be seen in the definitive diagnosis of UPJ stenosis.
Magnetic Resonance Imaging has the unique advantage of very quickly assessing renal blood flow, anatomy and urinary excretion.
In particular, the presence of small vessels causing UPJ stenosis is especially important in deciding what kind of surgery should be performed. see) low success.

Treatment:

Before giving information about treatment methods, it should be kept in mind that the condition due to poor urinary passage in UPJ may be temporary and may resolve spontaneously in children aged 18 months and younger.

However, in cases of stenosis and kidney damage caused by this stenosis, the chance of surgical treatment may be inevitable even if it is younger than 18 months.

While some infants or children may recover rapidly within months despite the severe UPJ stenosis detected in the first stage, others do not improve or begin to worsen. For this reason, very close follow-up is absolutely necessary in children in this age period. The family should be made aware of this. This follow-up is usually done by measuring the degree of enlargement (hydronephrosis) in the renal pelvis with periodic ultrasonography.

Surgical treatment is required in patients with a definitive diagnosis of UPJ stenosis and who do not think there is a chance of recovery over time. Open surgical techniques are classified in 3 basic groups. Classical UPJ stenosis surgery, such as flap type, incisional type and dismembered type, open surgery to remove the narrow UPJ section and ureter to the pelvis (kidney). This operation is called “Dismembered Pyeloplasty”, the success rate is around 95%. With the laparoscopic surgical technique that has come to the fore in recent years, pyeloplasty operations are also performed laparoscopically. The surgical procedure in open pyeloplasty is done exactly the same, but in this application, the patient does not make a large surgical incision, only 3 or 4 small holes are entered into the body and the operation is performed. The pyeloplasty surgery performed with this technique is called “Laparoscopic Pyeloplasty”. In scientific studies, there is no difference between laparoscopic and open surgical techniques in terms of surgical success. However, laparoscopic surgeries have some advantages over open surgery.

Another surgical treatment approach, called “Endoscopic Incision” or “Endopyelotomy”, with an endoscope through the urinary canal, is to enter the urinary canal and cut the narrow part from the inside with a closed system small cutter. Since this treatment is done through the urinary canal, it takes a very short time for the patient to return to daily activities. However, there are some factors that affect the success of “Endopyelotomy”. These factors affecting the success also cause the use of this technique to be limited. This procedure can be done by entering through the urinary canal or kidney.

Early complications of pyeloplasty are rare and prolonged urine leakage is often seen. If it lasts 10-14 days, stent placement is required. If fever, flank pain occurs, urinary leakage should be suspected or infection should be considered. In the late period, stenosis and recurrences may occur due to scarring.

Related Posts

Leave a Reply

Your email address will not be published.