Pelviureteric Junction (PUJ) Obstruction

What is a Pelviureteric Junction (PUJ) Obstruction?

PUJ obstruction is usually attributed to a birth defect which causes a blockage at the junction of the kidney drainage area (pelvis), and the tube that drains urine to the bladder (ureter). Although present from birth, the symptoms can occur at any time in life and sometimes can first present as troubling very late in life. PUJ obstruction can be associated with deterioration of kidney function, chronic back pain, infection, kidney stones and bleeding in the urine (haematuria).

How is a PUJ obstruction diagnosed?

PUJ obstruction is usually diagnosed with a functional study such as a special nuclear medicine scan known as a DTPA scan. A CT scan with intravenous contrast may be the first imaging that hints at the diagnosis. A PUJ obstruction can also have a typical appearance when dye is passed into the ureter from the bladder with a cystoscope inserted via the urethra.

How is a PUJ obstruction treated?

The gold standard of treatment is laparoscopic (keyhole) pyeloplasty although the surgery can be done with the use of robotic techniques or alternatively via traditional open surgery. The blockage is excised or cut away and a new join is made. A ureteric stent (or internal drainage tube) is left in place temporarily so that the new join heals over a period of 6 weeks.

What is the recovery after laparoscopic pyeloplasty?

The usual recovery is 3 to 4 days in hospital followed by a return to normal activity within 3 to 4 weeks.

What is the success rate of this procedure and are there any other options?

The success rate of laparoscopic pyeloplasty is about 95%, which is far superior to any other treatment. Very elderly patients who can’t tolerate a long anaesthetic can be managed with a ureteric stent that is changed on a 6 to 12 monthly basis. Alternatively incision of the blockage using a procedure called endoscopic pyelotomy can be performed, but the results are much less successful.