The ureter is a long, narrow structure, about 10-12 inches long, which carries urine produced in the kidneys to the bladder. The urine is moved by a process called peristalsis. The ureter actively forces the urine from the kidneys down into the bladder.
When there is a blockage that occurs within the junction that attaches the ureter to the kidney, this condition is referred to as ureteropelvic junction obstruction. This results in decreased flow of urine down the ureter, and an increased fluid pressure inside the kidney. This increased pressure in the kidneys can cause deterioration of the kidney’s function over time. This said obstruction can either be congenital (being that the patient was born with this condition) or develop over a period of time secondary to trauma or change in the body shape with age. The blockage can also be due to scar tissue, kinking, a blood vessel, or, in rare cases, a tumor.
Signs and Symptoms
An obstruction in the ureteropelvic junction can cause flank pain in the affected side. This pain may be intermittent and some patients may notice increased pain when drinking alcohol, coffee, or increased fluids. It is not uncommon for this pain to be in the front of the abdomen and it can also radiate down to the groin. In some cases, this condition may be accidentally detected on x-rays or ultrasound during an evaluation for unrelated problems. If and when an infection occurs in association with this obstruction, patients can become very ill and experience high fevers. In severe cases, this condition may require hospitalization, emergency drainage of the urine, and treatment with intravenous antibiotics.
Ureteropelvic junction obstruction can be treated with a common surgery referred to as pyeloplasty surgery. For children, open surgery is often done, but for adults, less invasive surgical options are preferred. During pyeloplasty surgery, a 2-3 inch cut is made just below the ribs. The obstructed segment of the ureter is removed, and the unobstructed portion is then reattached to the renal pelvis. A stent (a tiny wire-meshed tube) is placed to drain urine from the kidney. After the surgery is complete and the patient heals, the stent will be removed.
A more common approach currently for adults is robotic pyeloplasty or laparoscopic pyeloplasty. The same type of repair is performed on the patient, but instead of a 2-3 inch incision, multiple small, 8-10mm, incisions are made. A ureteral stent is still used as in open pyeloplasty.
After the pyeloplasty procedure, patients will remain in the hospital for a day or two, but recovery is usually quick. Patients may experience a swollen ureter, which may cause some pain for a few days after surgery. Kidney drainage may be poor at first, but this often gets better over time as the area heals. A few weeks after surgery, the stent will be removed, and the doctor may use an ultrasound to check for swollen kidneys.
Robotic pyeloplasty has the best long-term success for patients with ureteropelvic junction obstruction. After laparoscopic pyeloplasty, there may be scarring in the abdomen area, but the results of the surgery are very successful. Typically, it is uncommon for the obstruction to return, although, patients who have this surgery may be at risk for future kidney stones or infections.