ABSTRACT
Pelvi-ureteric junction obstruction (PUJO) is not a rare clinical entity. It is indeed one of the common urological conditions presenting most commonly with hydronephrosis and pain. The most common etiology for patients suffering from acquired PUJO is the presence of calculus/calculi. An aberrant renal vessel (now termed as a vascular bar) is one of the causes in adults which are often missed on pre-operative investigations and is detected intraoperatively. We present herein the case of a 28 years old female who came with complaints of loin pain for 2 – 3 months. The workup investigations revealed only hydronephrosis without any calculi. Thus, a diagnosis of the primary PUJO was made. The patient was successfully managed by a laparoscopic pyeloplasty.
ABSTRACT
Background: Pelvi-ureteric junction obstruction (PUJO) is defined as anatomical or functional obstruction to the flow of urine from the pelvis to the upper ureter. This may be unilateral or bilateral. Most of the hydronephrosis cases are due to Pyelo-ureteral junction obstruction (PUJO) which can be diagnosed antenatally. The treatment protocol for antenatal diagnosed PUJO is standardized. Few children present later in life. Present study was done to evaluate clinical profile and outcome of infants and children (<12years) presenting with PUJO. Methods: A retrospective observational study conducted by the department of Paediatric Surgery, SDM hospital Dharwad. All children with age less than 12 years with PUJO from March 2017 to March 2020 were included in the study (n=51). Initial evaluation was done with Ultrasound KUB (Kidney, Ureter, Bladder). A diuretic renogram/ EC (Ethylene cysteine) was done to confirm the diagnosis. The children were managed both conservatively and surgically (Pyeloplasty), depending on the presentation. The children were followed up post-surgery. Results: Fifty one patients were included in the study. Mean age of presentation was 31±30 months. Most common presentation was pain abdomen which was seen in 9 patients (17.6%). 6 patients (11.7%) presented with Lump and 2(4%) presented with fever. Left kidney was commonly involved (66%). Males predominate (80%). The mean antero-posterior pelvic dimension (APPD) of involved kidney was 30mm with range from 12.5mm to 68mm. 4 (7.8%) children presented with poorly functioning kidney with split renal function less than 10%. PUJO was associated with Pelvic calculi, VUR, Horseshoe kidney, Mal-rotated kidney. Out of the 51 patients, 9 (17.6%) were kept in conservative management 42 (82.3%) underwent Pyeloplasty. Among 42, 1 underwent redopyeloplasty and 1 underwent nephrectomy. In rest of the operated patients (Post-pyeloplasty) diuretic renogram showed improved drainage with improved function. Conclusions: PUJO is common cause of urinary obstruction in children. Earlier the diagnosis, better the outcome. Delay in diagnosis or presentation leads to increased chances of renal damage and loss. Hence it is important to diagnose PUJ obstruction at the earliest and receive prompt treatment.
ABSTRACT
Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.