Department : Laparoscopic Urology
What is PELVIC URETERIC JUNCTION (PUJ) OBSTRUCTION
The urine formed in the kidney collects in the kidney pelvis. This pelvis is connected to the bladder by a tube called the ureter. Sometimes there is obstruction at the junction of the kidney's pelvis and ureter. If the obstruction is complete, the function of the kidney will be seriously affected. The obstruction can be present at the time of birth or later, at any age. The commonest age of presentation is early in adult life.
The cause of obstruction is usually a developmental defect of the muscle in this region. It can be due to other causes also, such as an abnormal kidney artery in this region producing mechanical obstruction.
Kidney drains urine in to the bladder via renal pelvis and ureter. There can be a narrow segment at the junction of this renal pelvis and ureter in some people by birth. This narrow segment blocks the free flow of urine from kidney into the bladder. This is termed Pelvic Ureteric Junction Obstruction. This block may cause reduction in renal function if left untreated. In order to prevent renal failure later in life PUJO has to be treated at appropriate time without delay.
Symptoms of Pelvic Ureteric Junction Obstruction ( PUJO )
Most often it does not produce any symptoms. Now a days due to common usage of prenatal USG, PUJ Obstructions are more commonly detected during the anomaly scan done, during 5th week of pregnancy. Very rarely it prenatal USG is not done. Children present later in life with following symptoms.
How do you identify and confirm the problem
By means various investigations like
Treatment
Only treatment opinion available is Pyeloplasty. Where we cut the blocking portion of PUJ Obstruction and anastomose the normal pelvis and ureter. This procedure can be done by a key Hole Surgery.
Laparoscopic surgery gives equal results as open surgery with less post op pain, early discharge from hospital, early recovery and early resumption of daily activities.
How is it treated?
The treatment is by surgery. This can be done either by open surgery, with its accompanying morbidity of a 15 cm wound or in some cases, by endoscopic techniques ( endopyelotomy).
By far, the best results are obtained by open surgical techniques. Now laparoscopy can do the same repair with the same results but avoiding all the morbidity of the open surgical wound and is considered by many Urologists as the gold standard.
Steps of repair
Pre Operative Preparation
Surgery
Post Operative
At Home
For review