Pediatric Ureteropelvic Junction Obstruction Clinical Presentation

Updated: Apr 27, 2016
  • Author: Paul R Bowlin, MD; Chief Editor: Marc Cendron, MD  more...
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Presentation

History and Physical Examination

Urteropelvic junction (UPJ) obstruction is coexistent with other types of congenital abnormality in almost 50% of patients, and 10% of patients with UPJ obstruction show ipsilateral reflux. Voiding cystourethrography (VCUG) is well warranted. In such cases, more severe anomalies should be treated first. Some believe simultaneous repair of both conditions is not recommended, whereas others have performed simultaneous repairs with good results.

There also are instances of obstruction of both the UPJ and the ureterovesical junction. In these cases, UPJ obstruction should be treated first because most distal ureteral obstructions are not severe. Duplication anomalies usually cause UPJ obstruction at the lower poles. In these cases, suspicion of vesicoureteral reflux (VUR) also should be heightened.

In older children, periodic abdominal pain with vomiting is a common symptom. These symptoms are probably caused by intermittent kinking of the UPJ. Episodic flank pain following a diuresis is a common presenting feature in young adults but is uncommon in children. Rare urothelial tumors, such as benign fibroepithelial polyp or urinary stones, can mimic UPJ obstruction in children. Although rarely observed in developed countries, massive dilation of the renal pelvis and kidney fills the entire flank and abdomen. UPJ obstruction is a major cause of this condition.

UPJ obstruction is often associated with other congenital anomalies, including the following:

  • Imperforate anus
  • Contralateral multicystic kidney
  • Congenital heart disease
  • VATER (vertebra, anus, trachea, esophageal, renal) syndrome
  • Esophageal atresia

Renal ultrasonography is mandatory in such patients with the established diagnosis.