Treatments for Ureteropelvic Junction (UPJ) Obstruction in Children

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How is a UPJ obstruction treated?

In general, your child's treatment depends on the severity of the blockage. In mild cases, the flow of urine is affected only minimally and your child will likely not experience any symptoms at all. If the obstruction is larger, your doctor may choose to closely monitor your child with repeated ultrasound tests. In the most severe cases, where your child's kidney is at risk of damage from chronic backup of urine, surgery may be necessary.

Mild to moderate cases:

  • When you hear that your child has a ureteropelvic junction (UPJ) obstruction, it doesn't necessarily mean that he will need surgery. Some children may outgrow their UPJ obstructions without any treatment. 
     
  • If your child has a mild or moderate obstruction, your doctor may recommend a series of follow-up imaging studies to make sure her condition isn't getting worse or causing any kidney problems. 

How often will my child need to be seen?

Infants may be seen within the first three to four months of life to figure out the severity of the obstruction. If we're comfortable that it's not causing any harm to your child's kidneys, we'll likely repeat the ultrasound study within a few months. 

Severe cases:

  • If your child has a more severe obstruction, your doctor may prescribe antibiotics to prevent urinary tract infections. We'll also keep doing ultrasounds and renal scans until the condition has either gotten better on its own or worsened to the point that your doctor decides that surgery is necessary to fix it. 
     
  • Children with more severe cases of UPJ obstruction may require surgery. The most common reasons we recommend surgery to correct a UPJ obstruction are recurrent kidney infections, worsening of kidney swelling, or decline in kidney function.
     
  • Should your child's doctor decide that he needs surgery, Boston Children's surgeons have vast experience in both traditional open and minimally invasive robotic-assisted surgical procedures. You'll meet with your child's doctor and work together to design a customized plan of treatment that fits your child and his condition. 

Are antibiotics safe to take for an extended period of time?

Yes. We have treated thousands of children with preventive antibiotics for many years with very few severe side effects. The preventive antibiotics used are very low dose. There are some risks associated with any medication, but we believe that the benefits of preventing urinary tract infections and kidney damage in children with more severe UPJ obstructions outweigh any small risks from taking the antibiotics for long periods. 

Don't children become “immune” to the antibiotics?

Children do not become immune to antibiotics. Their immune systems continue to effectively fight off infections. However, the bacteria (germs) that live on and inside of human beings can become resistant to certain antibiotics. 

My child needs surgery. What's the procedure like?

The goal of the surgery is to remove the blockage in the ureter and allow urine to flow properly. If your child has a blockage, our surgeons locate the blockage, remove the blocked segment and reconnect the drainage system. 

What are the different options for surgical procedures?

There are two types of surgeries we can do at Boston Children's to treat your child's UPJ obstruction: 

Robotic surgery

At Boston Children's, we often perform state-of-the-art robotic surgery to treat UPJ obstructions. Your child's surgeon will make small incisions in his abdomen through small incisions, which are then used to perform the reconstructive procedures under the guidance of a small camera, also inserted through an incision.  The total length of all incisions added together is typically smaller than that used in open surgery. 

Open surgery

If your child's doctor decides that it's best to perform a traditional open procedure, the incision will be larger and your child will typically stay in the hospital for a few more days, but the procedure has proven very effective over the years and the results will be very similar. 

How might a UPJ obstruction affect my child's long-term health?

If they are detected early, most UPJ obstructions don't cause many problems. Even larger obstructions can be fairly easily removed, and your child should go on to have good urinary function. If left untreated, however, the chronic backup of urine into the kidney can damage your child's kidneys. 

Coping and support 

At Boston Children's, we offer many resources to help your child and your family deqal with your child's condition and treatment, including: 

Patient education: From the very first visit, our staff will be on hand to walk you through your treatment and help answer any questions you may have. We will also reach out to you by phone, continuing the care and support you received while at Boston Children's. 

Patient to patient: Would you like to talk with someone else whose child has been treated for a UPJ obstruction? We can put you in touch with other patients who have been through similar experiences and can share their stories. 

Faith-based support: If you are in need of spiritual support, we'll help connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions who will listen to you, pray with you and help you observe your own faith practices during the time you and your child are in the hospital. 

Social work and mental health professionals: Our social workers and mental health clinicians can offer counseling and assistance with issues such as coping with your condition, preparing for and recovering from surgery and dealing with financial difficulties. 

On our For Patients and Families site, you can read all you need to know about: 

We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”
- Sandra L. Fenwick, President and CEO

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