Ureteropelvic Junction Obstruction and Reconstruction
Ureteropelvic junction (UPJ) obstruction is a narrowing of the ureter (called a ureteral stricture) that carries urine from the kidneys to the bladder. Our urologists are highly experienced in complex surgeries for all types of ureteral strictures, of which UPJ is the most common.
When to See a Specialist
Ureteral stricture can be present since birth (a congenital condition) or can be caused later in life by kidney stones, fibrosis or scarring after surgery or radiation. The symptoms of ureteral stricture in adults include:- Urinary Tract Infection, typically accompanied by a fever
- Abdominal Mass
- Bloody Urine
- Kidney Stones
- Vomiting
- Pain in the upper abdomen or back, known as flank pain
Diagnosing UPJ
Your urologist will perform a thorough medical exam and may recommend tests such as an ultrasound, CT scan, MRI, kidney scan or retrograde ureteroscopy to identify any narrowing or blockage of your ureter. These tests help identify the cause and extent of your condition, and allow us to determine the best treatment approach.
Treating UPJ
If surgery is required, we use robotic surgical approaches whenever possible to correct UPJ and other ureteral strictures. We offer New Jersey’s most experienced robotic surgery team and have pioneered many procedures used for ureteral strictures. We also use enhanced imaging techniques during surgery to ensure successful reconstruction.
Surgical Approaches
- Robotic Pyeloplasty: The surgeon removes the blockage and the ureter is surgically reconstructed. This also helps prevent future problems.
- Buccal Mucosa Ureteroplasty: When scarring is so severe that pyeloplasty cannot be performed, the surgeon rebuilds the ureter using tissue from inside of the mouth.
- Ureterocalicostomy: The surgeon removes the obstructed section of the ureter and reattaches the ureter to the bottom of the kidney where urine forms and collects.
- Ureteroureterostomy: When the blockage occurs in the top or middle section of the ureter, the surgeon removes the obstructed area and connects the remaining portions of the ureter. If the stricture is small enough, a laser may be used to cut the stricture without the need for robotic surgery.
- Ureteral Reimplantation: The surgeon removes the ureter directly above the blockage, creates a new opening in the bladder and attaches the end of the ureter to this opening.
- Ureterolysis: The surgeon removes a mass of tissue or scar tissue that is pressing on one or both ureters known as retroperitoneal fibrosis.
