Ureteropelvic junction obstruction VUR (Vesico Ureteral Reflux)

Ureteropelvic junction obstruction (UPJO) and vesicoureteral reflux (VUR) are the most common urinary tract conditions in paediatric urology. Any degree of ureteropelvic junction obstruction is coexisted with VUR reflux. Vesicoureteral reflux is the most common abnormal condition that existed in a child's lower urinary tract. A ureter is a tube that drains urine into the bladder. Ureteropelvic junction obstruction in children occurs when a blockage occurs in ureters because of narrowing or obstruction near the kidney. It slows or stops the normal flow of urine from the kidney to the bladder. UPJ obstruction interferes with the function of the kidney which can damage the kidney.

The blockage generally forms in the fetus at the renal pelvis during kidney formation. It is detected in ultrasound testing before birth.

With vesicoureteral reflux, urine flows backward from the bladder up to the tubes (ureters) that connect kidneys to your bladder. Bacteria and other infections of the bladder can enter the kidney and cause kidney damage. Vesicoureteral reflux disorder can lead to the risk of urinary tract infections, if not treated early. It is most often seen in infants and children.

• Primary vesicoureteral reflux is of a low degree where the valve does not function properly and led the urine back into the ureters from the bladder. As the children grow up the ureter grows long and strengthens that improves valve and corrects the flow.
• Secondary vesicoureteral reflux is of significant degree disorder that may lead to the failure of the bladder muscle or damage to the nerves and eventually damage the bladder.

Signs and Symptoms included:

• A lump or mass in the abdomen
• Strong urge to urinate
• blood in urine
• Pain in abdominal, side, or back
• Urinary tract infection with fever
• Kidney infection and fever
• Vomiting and lack of appetite

When the connection between the ureter and the renal pelvis does not develop normally, it affects kidneys, ureters, bladder, and urethra.

There are certain risk factors for vesicoureteral reflux including:

• Bladder and bowel dysfunction (BBD) causes holding of urine and stool that lead to recurrent urinary tract infections
• White children are noticed with a higher risk
• Girls are at higher risk while growing up; however, it's more commonly detected in boys during birth.
• Infants and small children are more likely to have this disorder
• Family history of vesicoureteral reflux also increases the risk

An ultrasound during pregnancy reveals kidney problems and VUR before birth. Diagnosis tests after birth including:

• X-rays are taken when the dye passes through the kidney, ureter, and bladder
• Kidney ultrasound study is done to determine the degree of narrowing or swelling of the kidney.
• Nuclear renal scan to evaluate the extent of the blockage.
• Blood and urine analysis to check the kidney function
• A voiding cystourethrogram is conducted to emptying the bladder
• Placing catheter tube into the urethra

The paediatric specialists take care of the treatment plan after analysing the level of risk to the kidneys.

• Open pyeloplasty is used to remove the blocked or narrowed area of the ureter and then properly re-attached it to the renal pelvis to let the urine flow efficiently. It relieves symptoms and quite safer to use.
• Laparoscopic pyeloplasty is a minimally invasive surgery. A laparoscope targets the operating area and removes it. It causes less bleeding and infection and fast recovery.
• The majority of cases don't require surgery but regular monitoring is required to check the conditions of obstruction.

Very rarely, significant reflux could coexist with significant ureteropelvic junction obstruction when the ureter is severely dilated and tortuous. Repairing of both the upper and lower tract problems is done with surgical treatment. However, sometimes after the treatment of UJO, the reflux is corrected spontaneously.

Early diagnosis and treatment help to prevent kidney and urinary tract diseases in the future.