UPJ Obstruction in Adolescents: Episodic Pain, Sports, and Pyeloplasty

UPJ obstruction (ureteropelvic junction obstruction; informally, kidney outlet narrowing) diagnosed in adolescence is usually present from birth, but may never have been picked up on ultrasound as an infant, or a mild widening may have gone unmonitored. The narrowing can work "intermittently" for years without symptoms.

In intermittent obstruction, an ultrasound taken between episodes can look normal; the widening is only clear during the pain itself. This is why an ultrasound done during an attack — in the emergency department or at our clinic — is the most valuable test for catching the hydronephrosis (kidney swelling).

• Severe flank pain that doesn't ease, with vomiting: come in for an ultrasound while the pain is still present.
• Flank pain with fever (38 °C/100.4 °F and above): could be an obstructed, infected kidney — needs same-day evaluation.
• Visible blood in the urine or a marked drop in urine output: don't wait.

In infants, the main cause of UPJ obstruction is a narrow, non-contracting segment within the junction's own wall (intrinsic narrowing). In older children and adolescents, an extra vessel running to the kidney's lower pole pressing on the junction from outside (a crossing vessel) is more prominent; in those with episodic pain, the literature reports figures approaching half.

Symptomatic obstruction — that is, recurrent flank pain or a febrile urinary tract infection — is listed among the reasons for surgery in guidelines. Because the picture in adolescents is usually symptomatic, the decision is often clearer than for silent hydronephrosis in infants; even so, function, drainage and the degree of widening are all weighed together.

In the time between diagnosis and surgery, avoiding rapid, heavy fluid loading — especially drinking a large amount of water, coffee or energy drinks in a short time — can reduce attacks. Sports are generally not restricted; but discuss which activities are suitable with your doctor, since what triggers an attack varies from person to person.

• Once recovery from pyeloplasty is complete, most teenagers are expected to return to normal life, sports included; the timing for return to competitive and contact sports is decided at your follow-up visit. If a JJ stent is in place, frequent urination, burning and mild bloody urine can occur with vigorous exercise until the stent is removed — these are stent symptoms.