PUJ (pelvic-ureteric junction) obstruction is a rare but important condition, where there is a narrowing at the junction of kidney (renal pelvis) to ureter (image). This narrowing can result in loss of kidney function over time.
Other implications include:
- Pain, kidney infection as well as formation of renal stones.
PUJ obstruction is usually a congenital problems however in older patients it could be due to other causes such as scaring or cancer. For patients with congenital PUJ obstruction, the cause of the narrowing is often a crossing vessel which supplies blood to the lower segment of the kidney. This crossing vessel can cause a kink at the PUJ, resulting in obstruction.
What are the treatment options?
The main treatment option is surgical correction of the narrowing with an operation called Pyeloplasty. In this procedure, the PUJ segment is usually removed and the junction is reconstructed. The preferred approach for this surgery in through keyhole surgery, such as laparoscopic pyeloplasty or robotic pyeloplasty. The keyhole approach allows a faster recovery and earlier return to normal activity as well as reduced pain and smaller surgical scars.
Other treatment options include laser or incision of the blocked segments as well as stents which keep this narrowed junction open. These options are often for patients who are unfit to undergo surgery.