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Growth retardation, feeding difficulty, urinary system infection, sepsis, kidney stones, pain, and urinary bleeding may be seen. Older children may experience episodic pain and associated nausea and vomiting.
Diagnosis: The diagnosis can be made by detecting swelling in the kidney in the ultrasound follow-up performed in the mother’s abdomen. Although used frequently during follow-up, ultrasonography alone is not diagnostic in the diagnosis of UPJ stenosis. In ultrasonography, only the enlargement of the kidney pool, namely hydronephrosis and the structure and thickness of the kidney parenchyma tissue, is displayed.Pelvis anterior and posterior diameter is measured, but this neither makes the diagnosis of obstruction, nor shows that it has worsened and recovered. For definitive diagnosis, a method in which the flow of urine from the kidney to the urinary tract is evaluated functionally should be used. One of these classical evaluations is intravenous pyelography (medicated kidney film) called IVP. Here, an enlarged kidney pool is observed due to insufficient excretion of urine from the pelvis. In IVP, the dyestuff shown by the x-rays is given into the vein and this substance is filtered from the kidney. With serial films taken during the excretion of this substance with urine, kidney function, kidney collection systems, drug passage to the ureter and bladder are evaluated. Even if UPJ stenosis is shown in IVP, diuretic DTPA scintigraphy (renogram with diuretic) should be performed in the definitive diagnosis. This is important not only for a definitive diagnosis, but also for the follow-up of postoperative recovery. While the radioactive material given intravenously with the diuretic renogram is filtered from the kidney, the function and drainage in the two kidneys are measured and evaluated separately. In this evaluation, a drainage curve is obtained for both the right and left kidney. The curve with UPJ stenosis does not ejaculate and has a gradually increasing curve. This rising curve should be seen in the definitive diagnosis of UPJ stenosis. Magnetic Resonance Imaging has a unique advantage in evaluating kidney blood flow, anatomy and urine excretion very quickly. Especially the presence of small vessels causing UPJ stenosis is especially important in determining what type of surgery is performed, if there is the presence of crossing vessels that cause stenosis or increase the severity of the already existing stenosis, especially the operations performed by cutting inside the urinary canal (endopyelotomy, below) see) its success is low.
Treatment: Before giving information about the treatment methods, it should be kept in mind that the situation due to bad urine passage in the UPJ at 18 months and younger may be temporary and can recover spontaneously. However, in cases of stenosis and kidney damage caused by this stenosis, the chance of surgical treatment may be inevitable even if it is younger than 18 months. While some babies or children may recover rapidly within months despite the severe UPJ stenosis detected at the initial stage, some do not improve or begin to worsen. For this reason, it is absolutely necessary to follow up very closely in children in this age period. The family should be made aware of this issue. This follow-up is usually done by periodic ultrasonography to measure the degree of enlargement (hydronephrosis) in the renal pelvis.