Pelvi-ureteric junction obstruction (PUJ obstruction) is a condition that occurs when urinary flow is impaired from the renal pelvis. The renal pelvis is located at the upper end of each ureter, which is the tube that drains urine from the kidneys to the bladder. The renal pelvis, which is shaped like a funnel. It collects urine and drains it into the ureter. In PUJ obstruction, the flow of urine is slowed or stopped completely. This causes urine to pool in the renal pelvis which leads to kidney swelling (hydronephrosis). In most cases of PUJ obstruction, only one of the kidneys is affected.

Causes

Most often PUJ obstruction is congenital, either from narrowing of the internal lumen or by external compression from a vessel. It is not known how to prevent it. PUJ obstruction occurs in about one of every 1,500 births. Males are affected at more than double the rate of females, and the left kidney is affected more often than the right. The blockage occurs as the kidney is forming.

Though less common, PUJ obstruction may be acquired from secondary causes such as:

• Trauma from kidney stones or surgery.

• Cancer

• Infection

Symptoms

• Intermittent lank pain

• Nausea and vomiting

• Occasionally there are no symptoms and the condition is diagnosed Incidentally

Complications

If left untreated, PUJ obstruction may occasionally lead to complications including:

• Recurrent pain

• Kidney stones

• Recurrent infections

• Damage to the kidney over time

Diagnosis

The diagnosis is usually made by various imaging studies:

• Ultrasound imaging. This may show swelling of the kidney without swelling of the ureter

• CT or MRI imaging. This can also show swelling of the kidney and may also identify any extrinsic vessels causing compression in that location.

• MAG 3 scan. This is a nuclear medicine scan that looks at the drainage of a radiotracer from each kidney. Itt helps to identify if the kidney is partially or completely blocked (obstructed).

Treatment

Treatment for PUJ obstruction depends on the underlying cause

• Robotic pyeloplasty. The condition is usually treated by a surgical procedure known as robotic pyeloplasty. This procedure reconstructs the renal pelvis and ureter and aims to relieve symptoms and prevent damage to the kidney.

• Stents. Some patients who are not fit for robotic surgery can be managed with regular stent changes.

• No treatment. In some cases, no treatment is required and it is appropriate to carefully monitor the condition.

Contact

At Adelaide Urology Care, we are dedicated to giving you the personalized care you need. Please do not hesitate to contact us for more information. 

Male and Female Urological Anatomy

PUJ obstruction on CT Scan

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