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.

There are several degrees of renal pelvic dilation, ranging 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. If at any point during the pregnancy, a woman is diagnosed with the enlargement of the renal pelvis, close monitoring is recommended throughout the pregnancy. This involves closely tracking changes in the extent of renal pelvic enlargement, monitoring urine output, and observing the renal pelvis size throughout the pregnancy. In most cases, there is no need for premature delivery, but extreme cases might require early delivery.

Diagnosis:

For children diagnosed with renal pelvic dilation while still in the womb, ultrasound examination is usually performed as part of the newborn's assessment 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:

Not every child with renal pelvic dilation requires surgical intervention. Less than 50% of diagnosed cases necessitate surgical treatment. Surgical correction is recommended if:

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

In the past six years, the majority of corrective surgeries for renal pelvic dilation have been performed using minimally invasive robotic-assisted techniques, making use of advanced robotic technology for precise and less invasive procedures. The procedure involves small incisions and often includes the placement of an internal stent that is removed after a certain period.

Follow-Up:

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