Questions posted in the The Urology Forum have been answered by urologists from Henry Ford Health System and by Dr. Kevin Pho.

Question Title: UPJ Obstruction

Forum: The Urology Forum
Topic: Pediatric Urology

Hi! Welcome Back! I like your new format. I received IVP results yesterday and I hope you can help me understand them. I have a follow-up in a week and I want to have a good understanding of my condition. I had surgery for a UPJ Obstruction (no stones) 4 months ago. The procedure was called Acucise Endopyelotomy. On my follow-up IVP it says "The left kidney is moderately hydronephrotic, renal pelvis is dilated to the level of the UPJ,and left ureter is minimally visualized distal to that point. In the erect position, there is descent of the right kidney. Urinary bladder is smooth in outline, and postvoid film shows minimal residual. IMPRESSION: Partial Obstruction, left ureteropelvic junction." Can you tell from that whether my surgery was successful or may I be in for another round? Thanks!!! Linda


Dear Linda

Your question is very interesting. UPJ obstruction is a very common problem. With the advent of prenatal ultrasound it is often diagnosed prior to birth. However, there are a significant number of people who have this condition that are not discovered until adulthood. Symptoms include flank pain especially with increased fluid intake , urinary tract infections and stones.
There are several treatment modalities available for UPJ obstruction. Acucise endopyelotomy is a very well respected treatment option. The cure rate is approximately 80 to 85 %. Your IVP demonstrates evidence that you may still have some obstruction. The best test to determine that your surgery was successful is called a renal scan. This test allows the doctor to determine the function of each kidney as well as whether or not it is blocked. If this test shows blockage , you will most likely need a seond procedure. The choices for your second surgery include antegrade endopyelotomy and open surgery. Most urologists would perform open pyeloplasty which has a greater than 90 % success rate for patients who initially failed Acucise. In this procedure an incision is made in the flank region and the obstructed segment of ureter at the UPJ is removed and the ends are sewn back together. This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).

HFHS M.D.-KR
*keyword : UPJ obstruction

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