Ureteropelvic Junction Obstruction and Reconstruction

Ureteropelvic junction (UPJ) obstruction is a narrowing of the ureter (called a ureteral stricture) that carries urine from the kidneys to the bladder. Our urologists are highly experienced in complex surgeries for all types of ureteral strictures, of which UPJ is the most common.  

When to See a Specialist

Ureteral stricture can be present since birth (a congenital condition) or can be caused later in life by kidney stones, fibrosis or scarring after surgery or radiation. The symptoms of ureteral stricture in adults include: 

  • Urinary tract infection, typically accompanied by a fever
  • Abdominal mass
  • Bloody urine
  • Kidney stones
  • Vomiting
  • Pain in the upper abdomen or back, known as flank pain

Diagnosing UPJ

Your urologist will perform a thorough medical exam and may recommend tests such as an ultrasound, CT scan, MRI, kidney scan or retrograde ureteroscopy to identify any narrowing or blockage of your ureter. These tests help identify the cause and extent of your condition, and allow us to determine the best treatment approach. 

Treating UPJ

If surgery is required, we use robotic surgical approaches whenever possible to correct UPJ and other ureteral strictures. We offer New Jersey’s most experienced robotic surgery team and have pioneered many procedures used for ureteral strictures. We also use enhanced imaging techniques during surgery to ensure successful reconstruction. 

Surgical Approaches

  • Robotic pyeloplasty: The surgeon removes the blockage and the ureter is surgically reconstructed. This also helps prevent future problems.
  • Buccal mucosa ureteroplasty: When scarring is so severe that pyeloplasty cannot be performed, the surgeon rebuilds the ureter using tissue from inside of the mouth.
  • Ureterocalicostomy: The surgeon removes the obstructed section of the ureter and reattaches the ureter to the bottom of the kidney where urine forms and collects. 
  • Ureteroureterostomy: When the blockage occurs in the top or middle section of the ureter, the surgeon removes the obstructed area and connects the remaining portions of the ureter. If the stricture is small enough, a laser may be used to cut the stricture without the need for robotic surgery.
  • Ureteral reimplantation: The surgeon removes the ureter directly above the blockage, creates a new opening in the bladder and attaches the end of the ureter to this opening.
  • Ureterolysis: The surgeon removes a mass of tissue or scar tissue that is pressing on one or both ureters known as retroperitoneal fibrosis.

Why Choose Hackensack Meridian Health for Urology Care

Quality

Hackensack University Medical Center has been ranked the #1 Urology Department in New Jersey for eight years in a row by U.S. News & World Report and is the only urology department in New Jersey that is nationally ranked.

Innovation

The urologists at Hackensack University Medical Center have been performing robotic surgery for ureteral strictures for more than a decade. We perform more than 775 robotic procedures each year and have performed more than 5,000 robotic procedures over the last ten years.

Patient Experience

Hackensack University Medical Center is the first hospital in New Jersey to successfully perform surgeries using the da Vinci SP® Surgical System, which inserts all surgical instruments through one small abdominal incision, improving surgical outcomes and allowing quicker patient recovery.

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Our Doctors

Our award-winning team of renowned surgeons, physicians, researchers and other health care specialists are able to provide exceptional urological expertise, advancements and cutting-edge technology to develop a highly-personalized plan for each and every one of our patients.