PUJ obstruction
Pelviureteric junction (PUJ) obstruction is most commonly caused by a narrowing in the section of the ureter that drains urine from the kidney, resulting in a build-up of urine that raises the pressure within the kidney, potentially causing damage. It usually affects the left kidney more than the right, but it can affect both kidneys in 10% of cases. PUJ obstruction can be:
- intrinsic - the blockage occurs internally, such as due to stenosis (a narrowing of the passage)
- extrinsic - the blockage is caused by an external factor, such as an extra blood vessel crossing over the ureter.
Sometimes PUJ obstruction causes no symptoms or problems and is only discovered by chance during a scan for another condition. Alternatively, it can cause:
- Recurrent episodes of loin pain which tends to worsen after drinking especially alcohol.
- Kidney infection (pyelonephritis).
- Kidney stones.
- Lump or swelling in the kidney area.
- Kidney damage caused by high pressure in the renal pelvis, kidney infection, or the formation of kidney stones.
And sometimes, in adulthood, symptoms can include a sharp flank pain accompanied by nausea and vomiting; urinary tract infections; or swelling in the abdomen.
Diagnosis and Treatment
The following tests can be performed to identify PUJ obstruction and learn more about them:
PUJ obstruction is usually diagnosed before birth because it causes a dilatation in the urinary tract, which is visible on prenatal scans.
- Ultrasound scan
- MAG-3 renogram
- MRI
Treatment
Pyeloplasty is a procedure used to treat PUJ obstruction. The surgery can be done through an open incision or through laparoscopy, with or without robotic assistance. Recovery usually takes 72 hours.
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