UROLOGY · CONDITIONS
UPJ Obstruction
Blockage at the junction of the renal pelvis and ureter causing progressive hydronephrosis , correctable with laparoscopic pyeloplasty achieving >95% long-term success.
ABOUT THIS CONDITION
What is UPJ Obstruction?
Ureteropelvic junction (UPJ) obstruction blocks the flow of urine from the renal pelvis into the ureter, causing progressive hydronephrosis and renal impairment. It may be congenital (intrinsic narrowing or crossing lower pole vessels) or acquired. Presentation includes intermittent flank pain , classically after large fluid intake , haematuria, or incidental hydronephrosis. Dr. Vipin performs laparoscopic or robotic dismembered pyeloplasty (Anderson-Hynes) , the gold standard procedure , with success rates exceeding 95% and recovery within 1–2 weeks.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Intrinsic UPJ narrowing , abnormal smooth muscle or mucosa
- Crossing lower pole renal vessels compressing the UPJ externally
- High ureteral insertion into the renal pelvis (anomalous anatomy)
- Adhesions or kinking from previous infection or surgery
- Pelviureteric junction polyp (uncommon)
- Congenital , most cases are present from birth
CLINICAL DETAILS
KeyFacts
Diuretic renography confirms obstruction and measures differential renal function before surgery.
Laparoscopic Anderson-Hynes dismembered pyeloplasty , gold standard with >95% long-term success.
Robotic pyeloplasty offers superior intracorporeal suturing , preferred for complex or redo cases.
Internal stent protects the anastomosis post-operatively , removed at 4–6 weeks as outpatient.
Hospital stay 1–2 days. Light activity resumed within 1 week. Full recovery in 2–3 weeks.
Pyeloplasty performed laparoscopically in children >20 kg. Open approach for neonates.
HOW WE TREAT IT
Treatment Approach
Laparoscopic Dismembered Pyeloplasty (Anderson-Hynes)
The obstructed UPJ is excised and the spatulated ureter is reimplanted at the most dependent point of the renal pelvis , gold standard treatment for all UPJ obstructions including those with crossing vessels.
- 1
MAG3 & CT Urogram
Diuretic MAG3 renography confirms obstruction and quantifies differential renal function. CT urogram identifies crossing vessels.
- 2
Pyeloplasty
The obstructed UPJ is excised laparoscopically. The renal pelvis is trimmed. The ureter is spatulated and anastomosed to the dependent pelvis , the Anderson-Hynes technique.
- 3
JJ Stenting
A double-J stent is placed across the anastomosis intraoperatively to protect healing. Removed cystoscopically at 4–6 weeks as a brief outpatient procedure.
- 4
Follow-up Renography
MAG3 scan at 3 months post-operatively confirms resolution of obstruction and recovery of renal function drainage.
AVAILABLE TREATMENTS
Treatment Options
Laparoscopic Dismembered Pyeloplasty (Anderson-Hynes)
Gold standard , UPJ excised and ureter reimplanted to dependent renal pelvis. Applicable to all UPJ obstructions including crossing vessels.
Robotic Pyeloplasty
Robot-assisted pyeloplasty for superior precision suturing of the anastomosis , preferred for complex or redo repairs.
Open Pyeloplasty
Open flank approach for UPJ reconstruction when laparoscopic skills are unavailable or for complex redo repairs requiring wide access.
Endopyelotomy (Acucise / Laser)
Endoscopic incision of the UPJ , moderate success (75–85%), best for intrinsic short-segment obstruction without crossing vessels.
DJ Stenting (temporary)
Temporary internal stenting across the UPJ for decompression while definitive pyeloplasty is planned, or post-operatively to protect anastomosis.
COMMON QUESTIONS
Frequently Asked Questions
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