PUJ Obstruction
What is PUJ obstruction?
This is a blockage in the drainage tubes arising from the kidney. It may arise from an obstruction at the point the ureter joins the renal pelvis resulting in interference in the emptying of the renal pelvis. Other factors such as a blood vessel to the lower part of the kidney may "trap" the ureter .
How is it diagnosed?
Clinical findings may very according to patient age. It may be diagnosed in infants based on antenatal ultrasounds. In older patients it may be an incidental finding discovered on X-rays performed for another reason or patients may present with symptoms of pain (especially worse with alcohol).
Diagnosis primarily rest with X-rays tests such as ultrasound, intravenous pyelogram and nuclear medicine studies which examine the area of obstruction and also the effect of the obstruction on the drainage and function of the kidney.
What are the complications?
PUJ obstruction can cause a number of problems including loss of function in the affected kidney, , kidney infections, haematuria (blood in the urine) and renal stones. .
How is it treated ?
The need for treatment depends on the effect of the obstruction on the kidney , the presence of complications and the degree of patient symptoms . Surgery is reserved for those patients with pain, diminished kidney function or complications of the PUJ obstruction.
Patients not requiring surgery may be managed with surveillance with careful follow-up.
The most common surgical technique involves excising the PUJ and reconstructing it to remove the blockage. This may be performed using laparoscopic (key hole) surgery or with a robotic technique with success rates (based on improvement in patient symptoms and x-ray evidence of unobstruction) approaching 95%. Laparoscopy has significant benefits with patient recovery, reduced pain relief and shorter hospital stays compared with open surgery where a 10-15cm incision is required.
Other techniques involves incising the PUJ using a variety of techniques. In general these have a lower success rates than laparoscopic pyeloplasty.
Laparoscopic appearance PUJ obstruction
PUJ obstruction following reconstruction
