Ua ālai ʻia kou puʻupaʻa e kahi ālai ʻana i ka ureter? (Ureteropelvic Junction - UPJ Obstruction) E kamaʻilio kākou e pili ana i kēia!

I kekahi manawa, manaʻo kā mākou keiki liʻiliʻi he puʻupuʻu liʻiliʻi i loko o kona ʻōpū, a i ʻole loaʻa pinepine iā ia nā maʻi mimi, ʻeā? Malia paha me ke kuni. ʻO kekahi kumu o kēia mau mea hiki ke lilo i mea paʻa i kahi e hoʻomaka ai ka mimi mai ka puʻupaʻa. I kēia lā, e kamaʻilio kikoʻī mākou, maʻalahi loa, e pili ana i kēia kūlana i kapa ʻia ʻo `(Ureteropelvic Junction Obstruction)` a i ʻole `(UPJ Obstruction)`.

He aha kēia 'pale ʻana o ka ureteropelvic junction'?

I ka ʻōlelo maʻalahi, aia kahi wahi e like me ka funnel ma ka piko o kou mau puʻupaʻa ʻelua, a mākou e kapa nei ʻo `(Renal Pelvis)` . ʻO ka mimi e kahe ana mai nā puʻupaʻa e hōʻiliʻili i loko o kēia `(Renal Pelvis)`. A laila, hele kēia mimi i lalo i kahi ʻōmole i kapa ʻia ʻo `(Ureter)` a hōʻiliʻili i loko o ka ʻōpū mimi. ʻO ka hui ʻana o `(Renal Pelvis)` a me `(Ureter)` e kapa ʻia ʻo `(Ureteropelvic Junction - UPJ)`. Inā he poloka, ʻo ia hoʻi, he poloka, ma kēia hui ʻana no kekahi kumu, ʻaʻole e iho pono ka mimi. ʻO kēia ka mea a mākou e kapa nei ʻo `(UPJ Obstruction)`.

ʻO ka maʻamau, hoʻokahi wale nō `(Ureter)` o kēlā me kēia puʻupaʻa. Kānana ko mākou mau puʻupaʻa i nā huahana ʻōpala a me ke kahe keu mai ke koko a hana i ka mimi. ʻO ka mimi i hana ʻia ma kēia ʻano e hōʻiliʻili i loko o ka `(Renal Pelvis)`, hele ma waena o ka `(UPJ)`, a hele ma ke `(Ureter)` a hiki i ka ʻōpū mimi. Ke loaʻa kahi `(UPJ Obstruction)`, lohi loa kēia kahe ʻana o ka mimi, a i kekahi manawa hiki ke oki loa. Hoʻonui kēia i ka pilikia o ka hōʻino ʻia ʻana o nā puʻupaʻa.

ʻO ka hapa nui o ka manawa, ʻo kēia kūlana i kapa ʻia ʻo `(UPJ Obstruction)` he mea ia e kū nei i ka wā hānau (ʻo ia hoʻi, `(Congenital urinary abnormality)`). A hoʻopilikia pinepine ia i hoʻokahi puʻupaʻa wale nō. ʻO nā inoa ʻē aʻe no kēia ʻo `(UP junction obstruction)`, `(Obstruction of the ureteropelvic junction)`, a i ʻole `(UPJO)` no ka pōkole.

He maʻi koʻikoʻi anei kēia `(UPJ Obstruction)`?

ʻAe, he maʻi koʻikoʻi ka UPJ Obstruction. Inā ʻaʻole mālama pono ʻia, hiki iā ia ke alakaʻi i ka hāʻule ʻana o ka puʻupaʻa . No laila he mea nui e makaʻala i ia mea a hana i nā hana e pono ai. ʻAʻohe mea e hopohopo ai, akā pono ʻoe e makaʻala.

Pehea ka maʻamau o kēia kūlana?

Ma ke ʻano helu helu, ma kahi o hoʻokahi i loko o 1,500 mau pēpē i hānau ʻia he maʻi kēia (UPJ Obstruction). ʻO ke ʻano kēia, ʻoiai ʻaʻole ia he mea maʻamau loa, hiki ke hiki i kekahi.

He aha nā hōʻailona o kahi `(Ureteropelvic Junction Obstruction)`?

Aia kekahi mau hōʻailona maʻamau e ʻike ʻia ma kēia ʻano. Eia nō naʻe, i kekahi manawa, ʻoi aku hoʻi i nā pēpē ʻōpio, ʻaʻohe paha he mau hōʻailona o waho.

• He manaʻo e like me ka puʻupuʻu i loko o ka ʻōpū, ʻoi aku hoʻi ma ka ʻaoʻao o ka ʻōpū. Hoʻokumu ʻia kēia e ka pehu ʻana o ka puʻupaʻa ma muli o ke ālai ʻia ʻana o ka mimi. Ua like ia me kahi pōpō wai.
• Nā maʻi ʻōpū mimi pinepine (UTI), me ke kuni. Inā loaʻa pinepine i kahi keiki ʻōpio nā UTI, he mea kēia e noʻonoʻo ai.
• ʻEha ʻaoʻao. He ʻeha kēia ma ke kua o ka puʻupaʻa. I kekahi manawa hele mai kēia ʻeha a hele aku.
• Nā pōhaku puʻupaʻa. ʻOi aku ka nui o ka hiki ke hana ʻia nā pōhaku puʻupaʻa ke ālai ʻia ka mimi.
• Koko i loko o ka mimi (`(Hematuria)`) .
• Ka luaʻi a me ka luaʻi.
• Ka lohi o ka ulu ʻana a i ʻole ka emi ʻana o ke kaumaha o ke keiki . I kekahi manawa hiki ke ʻike ʻia kēia mau kūlana.

He aha ke kumu nui o ka UPJ Obstruction?

Ua ʻōlelo mua wau ʻo ka hapa nui o nā maʻi UPJ Obstruction he congenital . ʻO ke ʻano kēia, i ka wā e noho ana kahi pēpē i loko o ka ʻōpū, ʻaʻole i hana pono ʻia nā ʻāpana o ka ʻōnaehana urinary, ʻoiai ka ureter a i ʻole ka puʻupaʻa. I kekahi manawa, hiki ke hana ʻia kēia ālai ʻana e ke kaomi ʻana o kahi kīʻaha koko e hele ana ma o ka UPJ. He mau hanana maʻamau kēia. Eia nō naʻe, inā ua loaʻa i kekahi o kou ʻohana kēia maʻi, hiki iā ʻoe ke emi iho ka pilikia o ka loaʻa ʻana.

He mea kākaʻikahi loa i nā pākeke ke loaʻa ka "UPJ Obstruction". Eia nō naʻe, hiki ke loaʻa i nā pākeke ma muli o kēia mau kumu:

• Ma muli o nā pōhaku puʻupaʻa .
• Ma muli o nā maʻi ma ke ala mimi o luna ('Upper UTIs') .
• Ma hope o ke ʻoki kino ma ia wahi.
• Ma muli o ka pehu ʻana (`(Swelling)`) ma ka ʻaoʻao o luna o ka ʻōnaehana mimi .

ʻO wai ka mea i hoʻopilikia nui ʻia e kēia kūlana?

Wahi a ka ʻikepili o kēia manawa, ʻoi aku ka nui o nā kāne i ka loaʻa ʻana o ka UPJ Obstruction ma mua o nā wahine. Ua ʻike pū ʻia ka noiʻi ʻana he ʻoi aku ka nui o ka loaʻa ʻana o kēia maʻi ma ka puʻupaʻa hema ma mua o ka puʻupaʻa ʻākau.

He aha nā pilikia e hiki mai ana o ka UPJ Obstruction?

Inā ʻaʻole mālama pono ʻia kēia maʻi (UPJ Obstruction), hiki ke loaʻa nā pilikia like ʻole.

• Nā maʻi ʻōpū mimi hou (UTI) . I kekahi manawa, hiki i nā ʻiʻo momona a puni nā puʻupaʻa ke pehu (perinephric stranding).
• Hiki ke loaʻa ka ʻeha mau loa ma ka wahi i hoʻopilikia ʻia .
• Hiki ke hoʻokumu ʻia nā pōhaku puʻupaʻa hou aʻe ("nā pōhaku puʻupaʻa lua") .

ʻO ka mea nui loa , inā ʻaʻole mālama ʻia no ka manawa lōʻihi, hiki i kēia `(UPJ Obstruction)` ke hōʻino i nā puʻupaʻa a hiki i ka hāʻule ʻana o nā puʻupaʻa . ʻO ia ke kumu he mea nui e ʻike a mālama iā ia i ka wā mua.

Pehea e ʻike ai i ke kūlana `(UPJ Obstruction)`?

I ka hapanui o nā hihia,Hiki i nā kauka ke ʻike i ka UPJ Obstruction i ka wā o ka ultrasound scan ʻoiai ke pēpē i loko o ka ʻōpū. ʻO kēia no ka mea ʻo ke ālai ʻana o ka mimi e kau ana i ke kaomi ma ke kua o ka puʻupaʻa, e hoʻoulu ai i ka pehu ʻana ma mua o ka maʻamau. Ua kapa ʻia kēia he hydronephrosis . Hiki ke ʻike maopopo ʻia kēia ma ka ultrasound.

ʻOiai ma hope o ka hānau ʻana o ke pēpē, hiki i nā kauka ke kauoha i nā hoʻokolohua like ʻole e ʻike i ke ʻano o ka hana ʻana a me ka hoʻokuke ʻana o nā puʻupaʻa i ka mimi. ʻO kēia mau mea:

• Nā hoʻāʻo koko a me ka mimi (`(Nā hoʻāʻo koko a me ka urinalysis)`). Hiki i nā hoʻāʻo e like me `(Blood Urea Nitrogen - BUN)` a me `(Creatinine Clearance)` ke hōʻike i ka maikaʻi o ke kānana ʻana o nā puʻupaʻa i ke koko.
• ʻO kahi hoʻokolohua i kapa ʻia ʻo "Intravenous Pyelogram - IVP" e pili ana i ka hoʻokomo ʻana i kahi waihoʻoluʻu kūikawā i loko o kahi aa koko ma kou lima a lawe i nā kiʻi "X-ray". A laila hiki ke ʻike ʻia ka waihoʻoluʻu i kona hele ʻana ma o ka puʻupaʻa, "Renal Pelvis", a me "Ureter" e hoʻoholo ai inā he mea paʻa.
• ʻO ke scan Renal. Ma kēia hoʻāʻo, ua hoʻokomo ʻia kahi liʻiliʻi o ka mea radioactive i loko o kahi aa a hoʻohana ʻia kahi kāmela kūikawā e nānā iā ia e hele ana ma o nā puʻupaʻa. Hiki i kēia ke hāʻawi i kahi manaʻo maikaʻi o ka hana maikaʻi o nā puʻupaʻa a me ka nui o ka paʻa ʻana.
• ʻO ke kani ʻana o ka ultrasound, CT scan, a me MRI. Hiki i kēia mau hoʻokolohua kiʻi ke ʻike maopopo i ke ʻano o nā puʻupaʻa, nā ureters, a me ka ʻōpū mimi, a me nā mea āpau e ālai ana i nā puʻupaʻa.

Pehea e mālama ʻia ai ka `(UPJ Obstruction)`?

Aia maoli kēia i ke kūlana. Inā loaʻa i kāu pēpē kahi UPJ Obstruction, hiki iā ia ke hoʻomaikaʻi iā ia iho i loko o nā mahina 18 mua o ke ola. I loko o kēia manawa, e hana ke kauka o kāu pēpē i nā scan ultrasound maʻamau a me nā hoʻokolohua ʻē aʻe e hōʻoia i ka ʻole o ka pōʻino.

Eia nō naʻe, inā ʻaʻole hiki i ke keiki ke mimi ma hope o 18 mau mahina, ʻo ia hoʻi ke paʻa nei, pono paha ʻo ia e hana i kahi hana i kapa ʻia ʻo "Open Pyeloplasty" . Ma kēia, hana kahi urologist pediatric i kahi ʻoki nui, wehe i ka ʻāpana i paʻa, a hoʻopili hou i ka "Ureter" i ka puʻupaʻa, e hana ana i kahi puka ākea iki. ʻO ka "Open Pyeloplasty" maʻamau he mau hola, a he 95% ka holomua.

I kekahi mau hihia, hiki i ke kauka lapaʻau ke hana i kēia ʻoki kino me ka hoʻohana ʻana i kahi ʻano hana i kapa ʻia ʻo `(Minimally invasive pyeloplasty)`, he ʻano hana robotic (`(surgical robot)`) . A laila, hana ʻia kahi ʻoki liʻiliʻi a hoʻohana ʻia kahi `(Laparoscope)` a me nā mea hana ʻoki kino ʻē aʻe ma o kahi robot. Ua like ka holomua o kēia ʻano hana me ko `(Open Pyeloplasty).` Eia naʻe, pono kēia i ka mākaukau loea hou aʻe ma ka ʻaoʻao o ke kauka lapaʻau. Aia nō hoʻi ia i ka makahiki a me ka nui o ke keiki.

ʻO kekahi koho ʻē aʻe he kaʻina hana i kapa ʻia ʻo "Endopyelotomy".Ma kēia, hoʻokomo ke kauka lapaʻau i kahi mea hana i kapa ʻia ʻo "Endoscope" (he ʻōmole lahilahi me kahi kāmela) ma o ka urethra (ʻUrethra), ma ke ala o ka "Ureter", a nānā i ka mea i paʻa. A laila, hoʻokomo ʻia kahi uea ma o kahi kahawai ma ka "Endoscope", ʻoki i ka mea i paʻa me ia, a kau ʻia kahi "drain", ʻo ia hoʻi, he tube, ma laila. Waiho ʻia kēia "drain" ma kahi no kekahi mau pule a hiki i ka wā e ho'ōla ai. Ma ka "Endopyelotomy", ʻaʻohe pono e ʻoki ʻia, a ʻoi aku ka maʻalahi ma mua o nā ʻoki ʻelua ʻē aʻe. Eia nō naʻe, ʻoi aku ka haʻahaʻa o ka holomua. I kekahi manawa pono e hana ʻia kēia ma mua o hoʻokahi manawa.

Pehea ka wikiwiki o koʻu ʻoluʻolu ma hope o ka lāʻau lapaʻau?

Aia ia i ka lāʻau lapaʻau āu i loaʻa ai no kāu UPJ Obstruction. Hoʻōla ka hapa nui o ka poʻe i loko o ʻelua a ʻehā pule. Eia nō naʻe, ʻokoʻa kou kino, no laila e ʻokoʻa paha kou manawa hoʻōla. E hāʻawi kāu kauka iā ʻoe i ka manaʻo maikaʻi loa o kēia.

Hiki ke pale ʻia ke ālai ʻana o UPJ?

ʻAʻole i loaʻa i nā kānaka noiʻi lapaʻau kahi pilina ma waena o ka meaʻai a me ka meaʻai i ka wā hāpai a me ka ulu ʻana o ka UPJ Obstruction i loko o ka ʻōpū. ʻO ke ʻano kēia, ʻaʻohe mea hiki iā mākou ke hana e pale aku ai i ka UPJ Obstruction mai ka hānau ʻana.

Eia nō naʻe, no nā pākeke i hānau ʻole ʻia me ka UPJ Obstruction, ʻo ka pale ʻana i kēia mau mea e kōkua paha i ka hōʻemi ʻana i kēia pilikia:

• Ke kāohi nei i ke kūkulu ʻia ʻana o nā pōhaku puʻupaʻa .
• Ke pale nei i nā maʻi ʻōpū mimi (UTIs) .
• Ke pale nei i ka trauma i kou mau puʻupaʻa .

He aha ka manaʻo no ke kūlana `(UPJ Obstruction)`?

Inā ʻike mua ʻia a mālama pono ʻia, maikaʻi loa ka nānā ʻana no ka UPJ Obstruction. ʻAʻole loaʻa i ka hapa nui o nā keiki nā pilikia lōʻihi. Eia kekahi, inā ʻike ʻia ma mua o ka hānau ʻana, hiki i kekahi manawa ke hoʻopau me ka ʻole o ka lāʻau lapaʻau.

Eia nō naʻe, inā ua ʻike ʻia ʻoe me ka UPJ Obstruction ma hope o ke ola, aia ʻoe i kahi pilikia kiʻekiʻe iki o ka hōʻino ʻia ʻana o nā puʻupaʻa. I nā hihia koʻikoʻi, inā ʻaʻole mālama ʻia, hiki i ka UPJ Obstruction ke alakaʻi i ka hāʻule ʻana o nā puʻupaʻa a me ka make. ʻO ia ke kumu he mea nui ka ʻike mua a me ka mālama ʻana.

Āhea ʻoe e ʻike ai i ke kauka?

Inā loaʻa iā ʻoe a i ʻole kāu pēpē kekahi o kēia mau hōʻailona, ​​e ʻike koke i ke kauka:

• Inā he koko i loko o ka mimi (`(Hematuria)`) .
• Inā paʻa ia i kou lima e like me ka puʻupuʻu i loko o kou ʻōpū.
• Inā loaʻa iā ʻoe ka ʻeha ma ka ʻōpū o luna a i ʻole ke kua (`(ʻeha ma ka ʻaoʻao o ka ʻūhā)`) .
• Inā he kuni kou.
• Inā ua kūpilikiʻi ka ulu ʻana o ke keiki ("(Growth falling / failure to thrive)`) .

I ka manawa hea e pono ai ʻoe e hele i kahi Emergency Treatment Unit (ETU) ?

Inā ʻaʻole hiki iā ʻoe ke mimi, e hele koke i ka lumi pilikia kokoke loa.ʻAʻole kēia he mea e hoʻopaneʻe ai.

He aha nā nīnau āu e nīnau ai i ke kauka?

Hiki iā ʻoe ke nīnau i ke kauka i nā nīnau penei:

• Pehea ʻoe e ʻike ai i kēia maʻi `(Ureteropelvic Junction Obstruction)`?
• Manaʻo ʻoe e hoʻomaikaʻi ana ka UPJ Obstruction o kaʻu keiki me ka ʻole o ka lāʻau lapaʻau?
• He aha nā koho lapaʻau?
• Inā pono ke ʻoki kino, he aha ke ʻano hana āu e ʻōlelo ai?
• He aha ka manawa kūpono e hiki hou mai ai ka UPJ Obstruction?

He aha ka ʻokoʻa ma waena o ka `(Ureteropelvic Junction Obstruction)` a me ka `(Ureterovesical Junction - UVJ) Obstruction`?

I ka ʻōlelo maʻalahi, ʻo nā mea e ālai ai ka Ureteropelvic Junction (UPJ) a me ka Ureterovesical Junction (UVJ) e kū mai ana ma nā wēlau o kou urethra (ureter). ʻO ka UVJ kahi e pili ai kou ureter i kou ʻōpū mimi. Aia kahi mea e ālai ai ka UVJ ma laila. Akā, aia kahi mea e ālai ai ka UPJ ma ka Renal Pelvis, kahi e pili ai ka ureter i kou puʻupaʻa.

No laila, he aha ka leka e pono ai kākou e lawe i ka home mai kēia mau mea a pau?

He mea maʻamau ka makaʻu ke lohe ʻoe e loaʻa ana paha i kāu pēpē kēia pilikia, inā paha i ka wā o ka scan ʻoiai ʻo kāu pēpē i loko o ka ʻōpū a i ʻole ma hope o ka hānau ʻana. Manaʻo paha ʻoe e hoʻāhewa iā ʻoe iho, me ka noʻonoʻo ʻana, 'Ua hana hewa anei au? Aia kekahi mea hiki iaʻu ke hana e pale aku ai i kēia mai ka hana ʻana?' Akā ʻo ka ʻoiaʻiʻo, ʻo kēia kūlana i kapa ʻia ʻo `(Ureteropelvic Junction Obstruction)` he mea ia e hana wale ʻia i kekahi manawa. ʻAʻole hiki i nā kauka ke ʻōlelo pololei i ke kumu.

ʻO ka mea nui loa , hiki i nā kānaka he nui ke ho'ōla mai kēia kūlana `(UPJ Obstruction)`. No laila, mai makaʻu e ʻike i ke kauka a kamaʻilio me ia. Hoʻomaopopo lākou i nā nīnau a me nā makaʻu āpau āu e noʻonoʻo nei. E kōkua lākou iā ʻoe ma nā ʻano āpau a hiki iā lākou a pane i kāu mau nīnau āpau. ʻO ka ʻike mua ʻana a me ka mālama kūpono nā mea nui loa ma ʻaneʻi.

Nā puʻupaʻa, Ala Mimi, UPJ Obstruction, Pediatrics, ʻŌnaehana Mimi, ʻoki kino, Ureteropelvic Junction Obstruction