Kidney Swelling and UPJ Obstruction in Adults: Symptoms and Treatment

UPJ obstruction (ureteropelvic junction obstruction; informally, kidney outlet narrowing) is congenital in most cases; being diagnosed as an adult means the narrowing has stayed silent for years before becoming symptomatic late. Less often, acquired narrowing is seen following a prior stone, infection, or surgery.

Detailed EAU/ESPU and AUA guidelines exist for UPJ obstruction in children; there is no guideline specific to UPJ obstruction in adults. The information on this page is a review drawing on textbooks (Campbell-Walsh) and center case series; it is DRAFT text awaiting review by our physicians, and the figures vary by center.

• Our clinic is focused on pediatric urology; because Doç. Dr. Issı is also an adult urology specialist, cases transitioning from childhood to adulthood, as well as evaluation of UPJ obstruction in adults, can be handled by the same team.

The first test is ultrasound; it shows the degree of hydronephrosis, parenchyma (kidney tissue) thickness, and whether a stone is present. Next, MAG3 diuretic renography (a kidney scan) measures split (renal) function and drainage after furosemide (a diuretic) — this is one of the cornerstones of the treatment decision.

In adults, symptomatic obstruction, dropping function, recurrent infection, or stone formation are reasons for treatment; a symptom-free kidney with preserved, stable function can be followed. If treatment is decided on, the first choice at most centers is laparoscopic or robotic Anderson–Hynes (dismembered) pyeloplasty; the literature reports roughly 90–95% success.

• Laparoscopic or robotic pyeloplasty: first choice for most adults; with a crossing vessel, the ureter is moved in front of it.
• Endopyelotomy: short narrowing, good function, no vessel; lower success.
• Open pyeloplasty: a valid option with previous surgery or complex anatomy.
• Follow-up: serial ultrasound and MAG3 when needed, in a symptom-free kidney with preserved, stable function.

In an adult with known hydronephrosis, flank pain with fever can mean the obstructed kidney has become infected and needs same-day evaluation; in this situation, drainage (a JJ stent or nephrostomy) is used to control the infection first, and the definitive repair is postponed.

• Fever together with flank pain: same day.
• Severe pain that doesn't ease, vomiting, reduced urine output: don't wait.
• With a stent in place: fever, severe pain, noticeable bleeding: same day.

• Follow-up after surgery is similar to that in children: ultrasound around month 3, then every 6–12 months; MAG3 is repeated only if the widening increases or symptoms appear. The widening isn't expected to disappear completely; success means symptom-free, stable or decreased widening, and preserved function.