The ureter is a thin tubular structure about 10-12 inches in length that carries urine produced in the kidneys to the bladder. The urine is transported by a process known as peristalsis. The ureter actively propels urine from the kidney into the bladder. Sometimes, the ureter can become blocked in which case the flow of urine becomes decreased but the fluid pressure inside the kidney becomes increased. This condition is referred to as Ureteropelvic Junction Obstruction and occurs less frequently in female patients.
This blockage occurs at the junction where the ureter attaches to the kidney and can either be congenital (meaning the patient is born with it) or it may develop over time secondary to trauma or change in body shape with age. This blockage can be due to scar tissue, kinking, a blood vessel, or in some rare cases, a tumor.
Signs and Symptoms of Ureteropelvic Junction Obstruction
Women that are suffering from Ureteropelvic Junction Obstruction, may experience flank pain on the affected side. This pain may be intermittent, and some may experience more intense pain when drinking coffee, alcohol, or increased amounts of fluids. Some women may also experience pain in the front of the abdomen and can radiate down to the groin.
In certain cases, the condition may be detected by accident on x-rays or ultrasound during an evaluation for an unrelated issue. If infection occurs in concurrence with the obstruction, patients may become quite ill and have high fevers. In these instances, hospitalization, emergency drainage of the urine and treatment with intravenous antibiotics may be necessary.
In some cases of Ureteropelvic Junction Obstruction, there may not be any noticeable symptoms. Although, when symptoms do occur, they may include:
- Back or flank pain
- Bloody urine (hematuria)
- Lump in the abdomen (abdominal mass)
- Kidney infection
- Urinary tract infection, usually with fever
Pyeloplasty for Ureteropelvic Junction Obstruction
The UCA Women’s Center offers robotic, laparoscopic surgery to reconstruct an obstructed ureter and renal pelvis due to Ureteropelvic Junction Obstruction. The operation, known as pyeloplasty, can be performed by using the da Vinci robot system.
During this procedure, the obstructed, narrowed area at the junction of the kidney and the ureter is removed and the ureter and kidney are sewn back together over a hollow plastic tube called a ureteral stent. This stent is completely internal and remains in place for a month. It can be easily removed in the office when necessary. Pyeloplasty has a success rate of 95%.
The procedure requires a general anesthetic and hospitalization of usually two nights. Postoperative pain is less, recuperation is usually much quicker than other surgical treatments, and scarring is minimal when compared to other surgical treatments as well.