Pelviureteric junction (PUJ) obstruction
What is PUJ obstruction?
Pelviureteric juncture (PUJ) obstruction is a blockage of the pelviureteric juncture: the point at which the kidney’s pelvis – the area in its centre which collects urine – connects to the ureter tube, which transports urine to the bladder. Blockages at this critical point can cause urine to build up and be unable to leave the kidney.
Sandhurst Urology offers diagnosis, management, and medical intervention for PUJ obstruction from our clinic in Bendigo. To book an appointment, please ask your GP for a referral or call us directly.
Symptoms of PUJ obstruction
Signs of a PUJ obstruction may begin at any point in life – often at birth, but sometimes not until adulthood. If they do present, symptoms may include:
- A lump in the abdomen
- Kidney stones
- Blood in the urine
- Slow bodily growth (in infants)
- Frequent urinary tract infections (particularly in children)
- Pain in the upper abdomen or back (especially after drinking fluids)
Remember that your own experience with PUJ obstruction is individual – you may not experience every symptom and may experience slightly different symptoms to those specified. For further advice and diagnosis, book an appointment at Sandhurst Urology.
Diagnosing PUJ obstruction
Technological developments mean that PUJ is now often diagnosed in-utero. Doctors can see pelviureteric blockages on antenatal ultrasounds and administer treatment (if needed) when a child is born with it.
In adulthood, PUJ obstruction is sometimes detected on X-rays or ultrasounds taken to diagnose another condition. Your doctor may then follow up with other tests to assess its extent, including:
- Ultrasound – using ultrasonic waves, this imaging procedure lets a doctor see inside the abdomen and inspect the pelviureteric juncture for blockages.
- X-rays – these common tests allow your urologist to see the physical shape of your kidneys and pelviureteric junction. They may be performed with a contrast dye injection (an intravenous pyelogram), or be taken as you empty your bladder (a voiding cystourethrogram).
- Blood tests – these may include creatine clearance tests, blood urea nitrogen tests, and electrolyte evaluation, all of which analyse the amount of waste products in your blood. The results can indicate impaired kidney function.
- Nuclear renal scans – these involve injecting a tiny amount or radioactive material into your vein, then watching it through a gamma camera as it passes through your body. The test generally takes less than an hour, and all radioactive material is passed out through your urine by the end.
Preventing PUJ obstruction
PUJ obstruction is often congenital, developing in utero and being difficult to physically prevent. It can also develop later in life due to an event or illness which causes the PUJ to become physically blocked – causes for this include scarring in the ureter, a tumour, a large blood vessel, and even natural changes in the body’ shape that come with age.
As with any condition, always seek medical guidance to prevent and treat PUJ obstruction effectively. Ask your GP for a referral to Sandhurst Urology for individualised advice.
Treatments for PUJ obstruction
Many cases of PUJ obstruction in children resolve without treatment. However, cases which do not resolve or which are diagnosed in adulthood often need surgical management.
The main treatment for PUJ obstruction is pyeloplasty, a surgery which physically removes the ureter’s narrow section. When you are comfortably unconscious under a general anaesthetic, your urologist cuts away the PUJ’s narrowed section and stitches the ureter back onto the kidney. You may require a temporary urinary stent to help the kidney drain as it heals.
Sandhurst Urology proudly offers laparoscopic pyeloplasty: a minimally invasive alternative to standard pyeloplasty. This approach involves performing pyeloplasty through several small incisions in the abdomen, resulting in smaller and less noticeable scars than the open surgical alternative.
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