Treatment is not always necessary, and experts have different opinions. It is important to know that poor drainage in infants and children younger than 18 months may be temporary. Many infants with good kidney function and poor drainage at first will have much improvement after a few months. On the other hand, in some infants the obstruction won't improve it will get worse.
Young patients with an enlarged kidney are first followed with repeat ultrasounds and, if there is any concern, repeat nuclear scans. Sudden improvement can occur. If so, it often occurs in the first 18 months of life. If urine flow does not improve for an infant and obstruction remains, then surgery is needed. Adults may find treatment in other ways.
The classic treatment for infants is an operation called pyeloplasty. In this surgery the UPJ is removed, and the ureter is reattached to the renal pelvis to create a wide opening. This lets the urine drain quickly and easily. It also relieves symptoms and the risk of infection. The surgeon's cut is usually 2 to 3 inches long, just below the ribs. This process usually takes a few hours with a great success rate (95% success). The patient may have to stay in the hospital for a day or 2 after surgery. Drainage tubes can be used to promote healing.
Minimally Invasive Surgery
Newer surgical options are less invasive, such as:
- laparoscopic pyeloplasty with or without a surgical robot, or
- internal incision of the UPJ using a camera and scope inserted through the bladder
In this method the surgeon works through a small cut in the abdominal wall. A surgical robot can help guide the tools. The clear advantages of this method are less pain and nausea, especially in older children and adults. But scarring in the abdomen can result. This treatment has led to very successful results.
With this option a wire is inserted through the ureter. This wire is used to cut the tight and narrow UPJ from the inside. A special ureteral drain is left in for a few weeks and then removed. The UPJ heals in a more open manner but the surgery may need to be repeated. The success rates are lower than with open or minimally invasive surgery. But the advantages also include less pain and nausea.