PUJ

Kidneys filter the blood to remove waste, excess fluid, and maintain electrolyte levels. The renal pelvis connects the kidneys to the ureters, and any obstruction in the renal pelvis is called UPJ obstruction (ureteropelvic junction obstruction). The obstruction can be total or partial, preventing urine from passing through the kidneys to the ureters. This may lead to hydronephrosis—swelling of the kidneys due to urine accumulation.

Here are some causes of ureteropelvic junction obstruction:

• Congenital – the most common cause; often detected via ultrasound during pregnancy
• Kidney stones
• Previous surgery
• Abnormal blood vessels
• Tumor
• Upper urinary tract swelling

Individuals with ureteropelvic junction obstruction may experience:

• Abdominal or flank pain
• Presence of blood in urine
• Kidney stones
• Urinary tract infection (UTI)
• Kidney infection
• High blood pressure
• Deterioration of kidney function

Urologists recommend the following tests to diagnose PUJ obstruction:

• Blood Urea Nitrogen (BUN) and Creatinine Tests – assess kidney function. High levels indicate impaired filtration or obstruction.
• Intravenous Pyelogram (IVP) – a contrast dye is injected, followed by X-rays to visualize the kidneys, renal pelvis, and ureters.
• Nuclear Renal Scan – a radioisotope is used to assess kidney function and detect any blockage.
• CT Scan or MRI – provides detailed images of the urinary system and detects any obstruction or abnormalities.

In infants under 18 months, PUJ obstruction often resolves as the child grows. Prophylactic antibiotics and regular ultrasounds are used for monitoring. However, if the condition worsens or becomes severe, surgical intervention may be required.

The main treatment is pyeloplasty, which can be done via open surgery or laparoscopy:

• Open Pyeloplasty – A 2–3 inch incision is made below the ribs to access and remove the obstructed section. The ureter and renal pelvis are reconnected, and a stent is placed to aid healing.
• Laparoscopic Pyeloplasty – Performed using 3 small incisions (1–1.5 cm) in the abdomen. A scope and instruments are used to remove the obstruction and place a stent for healing. The stent is typically removed after 4 weeks.

Pyeloplasty has a high success rate of over 95%. Post-surgery recovery includes:

• Pain medications for post-operative discomfort
• Follow-up visits to monitor healing and surgical site
• Removal of the ureteral stent after about 4 weeks
• Ultrasound to assess resolution of hydronephrosis

Q: What is the full form of PUJ or UPJ Obstruction?
PUJ stands for Pelvic Ureteric Junction obstruction, and UPJ stands for Ureteropelvic Junction obstruction.

Q: What is PUJ/UPJ Obstruction?
It refers to a partial or complete blockage at the junction where the renal pelvis connects with the ureter. Most cases are congenital, but adult cases may result from stones, surgery, blood vessels, tumors, or swelling.

Q: What are the treatment options for PUJ/UPJ Obstruction?
The main treatment is pyeloplasty (open or laparoscopic). Both methods have high success rates and similar recovery periods, but laparoscopic surgery is generally more expensive.

Q: Is the treatment for PUJ/UPJ Obstruction successful?
Yes, both surgical options have a success rate of over 95%, making them effective solutions for managing ureteropelvic junction obstruction.