Paediatric Ureteropelvic Junction Obstruction Treatment In Children

A] Causes and Types of Ureteropelvic Junction Obstruction

Causes of Ureteropelvic Junction Obstruction:

The cause of ureteropelvic junction obstruction (UPJ) can either be congenital or acquired. In congenital causes, the obstruction develops before birth, whereas in acquired causes, the obstruction develops after birth. Let’s understand these in more detail:

• Congenital Causes
  The majority of the ureteropelvic junction obstruction (UPJ) cases are congenital. The structural abnormalities can cause trouble with the flow of urine from the kidney to the ureter. Some common congenital causes can be due to a narrow junction, an extra artery, abnormal attachments, and weak muscle coordination, among others. Other developmental issues can also lead to a malformed ureteropelvic junction obstruction.
• Acquired Causes
  While most ureteropelvic junction obstruction cases in kids are congenital, some are due to acquired causes. Some common causes include scars due to surgery, repeated UTIs, inflammation, compression, and more. In certain cases, even kidney stones can cause trouble.

Types of Ureteropelvic Junction Obstruction:

The two main types of ureteropelvic junction obstruction (UPJ) in kids include structural and extrinsic obstruction.

• Structural Obstruction
  Structural obstruction can be further divided into intrinsic and extrinsic obstruction. In intrinsic obstruction, the problem occurs within the ureteropelvic junction. Whereas in extrinsic, the problem occurs outside the ureteropelvic junction, also known as UPJ.
• Functional Obstruction
  In functional obstruction, there are no problems with the ureteropelvic junction (UPJ). Instead, trouble with muscle contraction exists. The reason behind this could be due to underdeveloped muscles, signal issues, weak muscle contractions, and more.

Now that we’ve understood the causes as well as the types, let’s understand some common symptoms to look out for.

B] Common Symptoms Of Ureteropelvic Junction Obstruction

• Abdominal pain
  Abdominal pain is one of the common signs of ureteropelvic junction obstruction in kids. A sudden pain can be observed if the fluid intake is suddenly increased. The fluid here could be your coffee, tea, any beverage or even water.
• Haematuria
  Signs of haematuria include spotting red or pink urine. The blood here occurs due to the increased pressure within the kidney.
• Hydronephrosis
  Hydronephrosis is recognised by swelling in the kidneys. Ultrasounds can be used to recognise hydronephrosis in children. If detected, hydronephrosis should be treated immediately to prevent the chances of other UPJ symptoms, such as nausea and UTIs.
• Nausea and vomiting
  Nausea and vomiting also form part of the ureteropelvic junction obstruction symptoms that often get ignored. The reason behind this could be due to an increase in pelvic pressure or intense abdominal pain.

C] Risk Factors For Paediatric Ureteropelvic Junction Obstruction

It’s important to understand that not all children will be affected by these risk factors. By understanding these factors, parents can prevent their children from long-term kidney damage.

• Family History And Genetics
  Studies indicate that children with a family history are at a greater risk of developing ureteropelvic junction obstruction. Even genetic variation is one of the risk factors for causing trouble with ureteropelvic junction obstruction.
• Associated Congenital Disorders
  Conditions such as vesicoureteral reflux, renal dysplasia and duplicated collecting systems can further increase the risk of developing ureteropelvic junction obstruction. Troubles due to narrowing at the UPJ, coordination with drainage, and others can be experienced.
• Prenatal Kidney Abnormalities
  Antenatal hydronephrosis can be found through ultrasounds done during pregnancy. If the foetal kidney is not able to drain urine, it indicates an area of concern. Structural abnormalities found in prenatal imaging can also show risks associated with ureteropelvic junction obstruction.

D] How Ureteropelvic Junction Obstruction Is Diagnosed In Children

A number of tests and evaluations can be done to understand the severity and health of your kidneys and seek expert help where intervention is required. For this, a detailed medical history to understand your symptoms can be done. Ultrasounds allow for early monitoring to detect conditions such as hydronephrosis in advance. Postnatal renal ultrasound is one of the non-invasive tools that is frequently used. A diuretic renal scan is another test that will tell in detail how each of your kidneys is performing. In case of repeated urinary infections, a VCUG can be done. Other methods, such as MRU and blood and urine tests, along with a CT urology, can be done.

E] Treatment Options For Paediatric UPJ Obstruction

A culmination of both surgical and non-surgical treatment options is available for ureteropelvic junction obstruction. These include:

• Surgical Options
  Pyeloplasty is considered the gold standard for ureteropelvic junction obstruction. Paediatric urology surgery options such as laparoscopic pyeloplasty and robot-assisted pyeloplasty can be implemented. These help to relieve pain while ensuring long-term protection against kidney damage.
• Minimally Invasive Procedures
  Minimally invasive procedures such as endopyelotomy and balloon dilatation can be performed. Let’s try to understand these in more detail:
• Endopyelotomy
  Endopyelotomy is a minimally invasive procedure that can be done for cases with mild or moderate ureteropelvic junction obstruction. As endopyelotomy involves small incisions, the recovery period is usually short.
• Balloon Dilatation
  Balloon dilatation, as the name suggests, involves a balloon that is inserted into the obstructed ureteropelvic junction and later expanded. Like endopyelotomy, balloon dilatation is another minimally invasive procedure that has a short recovery period.

F] Recovery and Follow-up After UPJ Surgery

After surgery, recovery forms a crucial phase in ensuring your child faces no complications or side effects from the surgery. Here are certain things that you need to pay attention to:

• Immediate Postoperative Care
  A hospital stay of 1-3 days may be required for minimally invasive pyeloplasty. Your doctor can prescribe medications that will help manage mild to moderate pain. Parents can be informed about the appropriate care to be taken after surgery.
• Activity Restrictions
  After surgery, light exercises instead of activities involving rough sports can be prioritised. This will allow for internal healing. Make sure to keep your hydration levels high to avoid any case of infection.
• Monitoring And Medications
  It’s important to track any changes in your urine. Similar to these, symptoms such as vomiting, fever, and pain should also be immediately reported. If any medicines are prescribed, they should be taken as per the given instructions.
• Follow-Up Visits
  Your first visit should ideally be after 1-2 weeks. Imaging methods, such as ultrasounds, can be done after 4-6 weeks. Other procedures, such as stent removal, are usually done 2-6 weeks after surgery.

G] When To Consult A Paediatric Urologist

You should talk to a paediatric urologist in the following cases:

• Intense Abdominal Pain
  Intense pain towards the side of your abdomen or lower back can indicate signs of abdominal pain.
• Frequent UTIs
  Painful urination, unclear urine, and fever are certain signs associated with UTIs.
• Blood In Urine
  If blood is visible in your urine, it indicates damage to the kidneys due to ureteropelvic junction obstruction.
• Swelling Of The Kidney
  The routine examination reveals swelling of the kidney caused by urine buildup.
• Sudden Changes In Urine Patterns
  Any changes in urine patterns, such as difficulty urinating, urinating frequently, and other similar troubles. You can read our blog on bladder control problems in children to understand your treatment options.
• Other Abnormalities
  If any abnormalities are found in the ultrasounds, they should be addressed.