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When a part of the kidney is blocked, this is called PUJO – Pelviureteric junction obstruction. Most of the time, it’s blocked at the pelvis of the kidney. This is where one of the ureters connects to the kidney (the tubes that carry urine to the bladder). The blockage makes it harder or impossible for urine to leave the kidney
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What exactly is meant by the term ” Pelviureteric Junction Obstruction“?
Pelviureteric junction obstruction, also known as PUJ obstruction, occurs when there is a limit in the passage of urine from the renal pelvis to the ureter. This condition, if it is not treated, might eventually result in the progressive deterioration of the kidneys.
The obstruction is never complete, nonetheless, the degree to which it exists might range anywhere from negligible to severe. In most situations, kidney function is not affected when the disease is only mild. Extreme cases have the potential to cause severe renal function impairment. Because of this, there is an increase in the size of the renal pelvis, which is caused by an obstruction in the flow of urine (hydronephrosis).
Significant hydronephrosis found on prenatal ultrasonography or in newborns is almost often the result of a PUJ blockage, also known as PUJO. This condition accounts for 48% of all cases.
What are the Causes of PUJO ?
The majority of the time, PUJO is congenital, which means that it was present from birth. This is typically due to an anomaly in the development of the muscle that surrounds the PUJ. Later in life, a person may develop PUJO for a variety of reasons, including the constriction of the ureter by aberrant blood vessels, inflammation, stones, or scar tissue.
Signs and Symptoms of an obstructed PUJ
The term “PUJ blockage” refers to a narrowing of the junction, which blocks the passage of urine from the kidney to the ureter. This condition is caused by a narrowing of the intersection.
About one person out of every one thousand people is affected by the illness, and men are more likely to be affected than women.
In other cases, the obstruction of the PUJ does not create any symptoms or other difficulties, and the condition is only discovered by accident when the patient is undergoing a scan to diagnose another condition. Alternately, it can bring about the following:
- Loin pain that worsens with alcohol.
- Infection of the kidneys (pyelonephritis).
- Stones in the kidney
- a mass or swelling in the region of the kidneys.
- A kidney infection, kidney stones, or elevated pressure in the renal pelvis can all lead to kidney damage. Kidney stones are another common cause of kidney damage.
Treatments of Pelviureteric Junction Obstruction
Open surgery has been the standard method of treatment for ureteropelvic junction obstruction for many years. During this procedure, the scarred area is removed, and the ureter is reconnected to the kidney. More recent treatment methods that are less intrusive have been developed throughout the course of the previous few years.
1. In the endoscopy technique, Endopyelotomy, a telescope or balloon containing an electric wire is inserted into the space between the kidney and the abdominal wall. After that, an incision is made into the middle of the scar tissue.
When compared to open surgery, these operations can be completed in a shorter amount of time than outpatient procedures, requiring only a tiny amount of anesthesia, and requiring significantly less time for recovery.
Patients will have to maintain a stent, which is a temporary inside tube, for anywhere between four and six weeks. These methods have a radiographic success rate that is between 15 and 20 percent lower than that which is acquired by open surgery. In addition, around forty percent of patients may experience substantial persistent discomfort after the treatment.
2. Pyeloplasty is a surgical treatment that disconnects the healthy portion of the ureter from the renal pelvis in order to create a large opening. During this surgery, scar tissue that was blocking the area is removed, and the healthy portion of the ureter is reconnected. The percentage of successful attempts is greater than 95%.
Infants typically undergo open surgery for the majority of their procedures. Laparoscopic versions of the same treatment are able to be carried out on older children as well as adults (keyhole surgery).
In most cases, a ureteric stent will be inserted to allow urine to be drained from the kidney that was operated on into the bladder via the area that is being repaired. In addition to that, you can have a tube that drains your bladder (urethral catheter).
When necessary, a nephrostomy tube is inserted into the kidney, with the other end emerging through a separate, smaller incision made in the flank region. This allows the kidney to be drained (this is done when placement of a ureteric stent was not possible). Sometimes a drain tube is put around the area of repair (outside of the kidney), in order to remove any blood or urine accumulation that may have occurred.
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Get your questions answered by our Doctor.
An obstruction at the ureteropelvic junction (also known as UPJ obstruction) is a blockage that occurs in the area that joins the renal pelvis (a portion of the kidney) to one of the tubes (ureters) that carry urine to the bladder. In most cases, it takes place while the baby is still developing inside the mother’s womb. This is what doctors refer to as a congenital condition (present from birth).
A ureter, or urethra, is a tube that connects your kidney to your bladder. A pyeloplasty is a form of surgery that restores the ureter. Obstruction of the ureteropelvic junction (UPJ) can be corrected with an inpatient operation that may be performed by either a general surgeon or a urologist. It is expected that you will be in the hospital for a total of two days.
In conclusion, regardless of the beginning level of relative performance, the renal function did not improve as a result of the pyeloplasty procedure. Some patients whose hydronephrosis was discovered prenatally and who were initially followed with observation had their differential function diminish after pyeloplasty, according to the findings of a renal scan. These patients had initially been observed.
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