Pelvi-Ureteric Junction Obstruction

A PUJ obstruction, or pelvi-ureteric junction obstruction, occurs when there is a blockage at the junction where the renal pelvis transitions into the ureter. This condition can impede the normal flow of urine from the kidney to the bladder, leading to a build up of urine in the kidney, known as hydronephrosis. The causes of a PUJ obstruction can vary, including congenital anomalies, scarring from previous surgeries or infections, and the presence of kidney stones.

Diagnosis of a PUJ obstruction typically begins with a combination of patient history and physical examination, followed by imaging studies. Ultrasound is often the first imaging modality used due to its non-invasive nature and ability to detect hydronephrosis. Other diagnostic tools may include a diuretic renogram, which assesses the function of the kidneys and the drainage efficiency of the renal pelvis and ureter. Additionally, computed tomography (CT) scans or magnetic resonance imaging (MRI) may be employed to provide detailed anatomical information and help in planning any necessary surgical interventions.

Pelvi-ureteric junction (PUJ) obstruction can present with a variety of symptoms, which may vary in severity among individuals. Commonly, sufferers may experience pain in the loin or abdomen, often as a result of urine build-up leading to kidney swelling. This pain can be intermittent or continuous and is sometimes exacerbated by fluid intake or physical activity. In severe cases, an individual might develop urinary tract infections, which could manifest as fever, painful urination, or cloudy urine. Another symptom to be vigilant of is haematuria, where blood is present in the urine, often indicative of underlying kidney distress. Additionally, some people may experience nausea and vomiting, especially during episodes of intense pain. In children, symptoms might also include failure to thrive or growth disturbances.

PUJ obstructions are typically treated based on the severity and symptoms presented. Mild cases may be monitored with regular imaging and observation to ensure they do not progress. For more severe instances, surgical intervention is often required to correct the obstruction and restore normal flow of urine. The most common surgical procedure for treating PUJ obstructions is pyeloplasty, which involves removing the obstructed segment and reattaching the healthy segment to the renal pelvis.

Minimally invasive techniques such as laparoscopic pyeloplasty or robotic-assisted pyeloplasty (both performed by Dr Deanne) are increasingly preferred due to their reduced recovery times and minimised post-operative discomfort. A crucial part of the treatment process involves consulting with Dr Deanne to determine the best course of action.