PUJ Obstruction

Pelvi-ureteric junction obstruction (PUJ obstruction)

Idiopathic PUJ obstruction

More common in men
Affects left kidney more often than right
10% cases are bilateral
Cause is unknown but important factors may be: abnormal lower pole vessels; persistant foetal urothelial fold

Clinical features

Usually presents in adolescence or early adult life
Presenting symptom may be loin pain – worse after alcohol
In late cases a renal mass may be palpable
Haematuria is an uncommon feature
10% develop UTIs (urinary tract infection) and 3% renal colic (pain)

Investigation

Diagnosis can be confirmed by ultrasound
IVU or retrograde ureterogram show a classical appearance
Isotope renography allows assessment of percentage of renal function

Surgical Intervention for PUJ Obstruction

If the transition from the renal pelvis to the ureter is narrow, the urine will not drain easily and backs up causing dilatation of the collecting system proximal to that point and enlargement of the renal pelvis. This dilatation of the collecting system is referred to as hydronephrosis.

The aims of treatment are to:

Relieve symptoms
Preserve renal function

This can be achieved by a pyeloplasty. If severe renal impairment (<20% function) a nephrectomy may be required. Both pyeloplasty or nephrectomy (removal of kidney) can be achieved by open or laparoscopic method.

Now pyeloplasty is done laparoscopically by Dr.Ramesh at Apollo Hospitals, Chennai as minimally invasive procedure.

Current advancement in treatment of PUJ obstruction is Robotic assited Laparoscopic Pyeloplasty.

Precise mucosa to mucosa anastomosis
Useful in redo surgery

Currently minimally invasive treatment like endopyelotomy is also available.