Pyeloplasty Treatment for Children and Adults

What is UPJ obstruction?

The ureteropelvic junction (UPJ) is where the kidney’s collecting area (renal pelvis) joins the ureter, the tube that carries urine to the bladder. If this junction is narrow, or a blood vessel crosses and presses on it, urine backs up and the kidney swells. This is called hydronephrosis. In children, UPJ obstruction is often detected on an antenatal scan before birth. In adults, it may show up as flank pain, especially after drinking a lot of fluid, repeated infections or kidney stones.

Symptoms

• Pain in the side or back, often worse after drinking large amounts of fluid
• Repeated urinary tract infections with fever
• A swelling in the abdomen in infants
• Kidney stones forming in the swollen kidney
• Blood in the urine
• Gradual loss of kidney function, sometimes without symptoms

How it is diagnosed

• Ultrasound to see how swollen the kidney is
• DTPA or EC renal scan (diuretic renogram) to measure how each kidney is working and whether drainage is truly blocked
• CT urography in adults, to show the anatomy and any crossing vessel

Not every swollen kidney needs surgery. Many babies with mild antenatal hydronephrosis improve on their own and are simply monitored. Surgery is recommended when the scan shows true obstruction, falling kidney function, worsening swelling, pain or infection.

Laparoscopic pyeloplasty

Pyeloplasty is the gold standard treatment for UPJ obstruction, with success rates above 90 percent in published studies. In laparoscopic (keyhole) pyeloplasty, the narrow segment is removed and the healthy ureter is re-joined to the renal pelvis through three or four small cuts. A DJ stent is placed temporarily to support healing and is removed after about four to six weeks. Compared with open surgery, the keyhole approach means less pain, smaller scars, a shorter stay and a faster return to school or work.

Recovery

Most patients stay in hospital for two to three days. Children usually return to normal play within two weeks, and adults to desk work in one to two weeks. A follow-up ultrasound and renal scan a few months after surgery confirm that the kidney is draining well.

Pyeloplasty in Koramangala and Bellandur

Dr. Bivek Kumar treats UPJ obstruction in infants, children and adults at Superhealth Hospital, Koramangala (OPD Monday to Saturday, 9 am to 6 pm) and Nelivigi Multispeciality Hospital, Bellandur (OPD Tuesday, Thursday and Saturday, 7 pm to 8 pm; Sunday by appointment only). For more on children’s urinary problems, see paediatric urology.

More questions patients ask

My baby’s scan showed a swollen kidney. Does my child need surgery?

Not necessarily. Many cases of antenatal hydronephrosis settle without treatment. Regular ultrasound and a renal scan help decide if and when surgery is needed.

How successful is pyeloplasty?

Pyeloplasty is highly successful, with more than 90 percent of patients having good long-term drainage.

When is the stent removed after pyeloplasty?

The DJ stent is usually removed after four to six weeks in a short day-care procedure.

Can adults have pyeloplasty?

Yes. Adults with UPJ obstruction, including those whose problem was missed in childhood, benefit from laparoscopic pyeloplasty.