PUJ Obstruction

What is PUJ Obstruction?

A pelviureteric junction is the point at which the kidneys’ collecting system – otherwise known as the renal pelvis – join to the narrow tube or ureter, which takes urine into the bladder. A PUJ obstruction occurs when that joint is narrowed, and the urine flow downwards from the kidney, is impaired. The result is that the kidney and the collecting system – renal pelvis – become dilated, which can be seen on ultrasound, most commonly.

Who is Affected?

Many children are affected by PUJ obstruction, though in most, it may be mild. It is often diagnosed antenatally, and is the most common cause of hydronephrosis seen at this stage. In older children, intermittent pain in the abdomen can occur, often specifically on the side of the kidney, and this can be misdiagnosed as indigestion or other abdominal pains, and might not be exclusively found until an ultrasound scan is performed, revealing a dilated kidney.

How is it Diagnosed?

PUJ obstruction is diagnosed with a combination of ultrasound scanning, followed up with functional imaging, which shows whether or not kidney function has been impaired by the process of obstruction. Many kidneys function well whilst dilated and surgery is therefore not necessarily required. It is determined in the patients’ who will both require and benefit from surgery, necessitating a Paediatric Urologist’s assessment.

What is the Treatment?

Although treatment is often conservative, pyeloplasty is used in those patients who have significant dilatation or impaired function in the kidneys. It is also used in patients presenting with pain, as pyeloplasty is affective in resolving such a nasty symptom. The pyeloplasty itself is a procedure performed on the outlet of the kidney, creating a new junction between the kidney pelvis and ureter. This is wide and free of obstruction and therefore resolves the problem.