Pelvi-ureteric junction (PUJ) obstruction
Pelvi-ureteric junction (PUJ) obstruction
PELVI-URETRIC JUNCTION OBSTRUCTION (PUJO) (also- Ureteropelvic junction obstruction- UPJO)
Definition
One of the main jobs of the kidney is to filter the blood, and then these waste products go via urine to the bladder. The urine leaves the kidney, enters the renal pelvis, and then passes into the ureter through a funnel called the pelvi-ureteric junction(PUJ). In some children, there can be a partial block at the PUJ. The block may be severe (high grade), minimal (low grade) or intermittent.Symptoms of PUJ obstruction
The obstruction is usually due to an abnormality in the development of the muscle at the PUJ and causes urine to collect in the kidney. We detect many patients with PUJ problems before birth because of enlargement of the kidney (hydronephrosis) seen on the prenatal ultrasound. Older children may have pain (related to the blockage), urine infection (due to stagnation of urine caused by the PUJ blockage), or kidney stones. Prolonged blockage, particularly with infection, can damage the kidney. Sometimes, the block can be due to abnormal blood supply to the kidney.Diagnosis
➾ Ultrasonography (USG) is the basic screening test which tells about the degree and severity of hydronephrosis (enlargement of the kidney) related to the PUJ obstruction.➾ Nuclear Renal Scan or a Diuretic renal scan (DRS) is done to evaluate the urinary flow across PUJ and function of the kidneys. The best scan for this is a EC scan or a MAG3 scan.Treatment of PUJ Obstruction
Antenatally detected PUJ Obstruction if not very severe is observed and a regular USG is done to see for any increase in severity. Also, a renal scan is done to make sure that the kidney function is preserved while waiting. Almost 60-70% of these children become better within the first 2 years of age and the hydronephrosis decreases. While in others, surgery may be required. Indications of surgery➾ Increasing hydronephrosis ➾ Decreasing kidney function ➾ Decreasing kidney cortex on USG ➾ Symptoms in form of pain, infections, HematuriaThe usual repair of a PUJ obstruction (pyeloplasty) involves removing the blockage, and reconnecting the ureter to the renal pelvis. Depending on the individual circumstances, a tube may be left across the pyeloplasty (DJ stent) or a tube may be left above the repair to decompress the kidney (nephrostomy).Technique of Surgery
The basic steps of pyeloplasty as mentioned above remain the same. The first step is to do a Cystoscopy and a Retrograde pyelogram (RGP). This a special x-ray study done under anesthesia to confirm everything before surgery and also to decide the exact site of incision.➾ Conventional Open surgery: Pyeloplasty is performed by a small incision on the back and side of the tummy. ➾ Laparoscopic Pyeloplasty: The area of block is approached by key hole laparoscopic approach. Laparoscopic pyeloplasty is one of the most challenging reconstructive surgeries in pediatric laparoscopy. It involves dissection of the pelvi-ureteric junction, excision of junction & excess pelvis and then re-stitching the junction back properly through a telescope and two small key hole incisions on the belly. Laparoscopic pyeloplasty may take a slightly longer time than open surgery, but is compensated by a fast recovery and less pain post-operatively. There are hardly any stitch marks on the belly. Laparoscopic pyeloplasty is technically difficult in children less than one year of age due to the limitation of the working space in the belly and longer anesthesia times in smaller babies, but the post-op pain is much less and recovery is very fast, making it worthwhile to do a pyeloplasty laparoscopically.Follow-up after pyeloplasty (repair of PUJ obstruction)
The DJ stent is removed after 6-8 weeks by cystoscopy under a short sedation at 6-8 weeks after surgery.Ultrasound is done after about a month of stent removal and a renal scan 3-4 months later. A child should be followed up for at least several years after a pyeloplasty. Even after successful repair of a PUJ obstruction, the hydronephrosis in the kidney may persist and an ultrasound may still “look abnormal”. Tests that evaluate kidney function, such as the renal scans, are better ways to follow children after repair.Testimonials
Real reviews from our patients on Google
Kranti Tandel
2 months ago
From the moment I walked into the hospital until the day I was discharged, I felt genuinely cared for.
A heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Read moreA heartfelt thank you to Dr. Manish Dubey for making such a stressful time feel so much easier. His calm nature, patience, and the way he explains everything instantly put me at ease. They say half the healing begins when you trust your doctor, and that’s exactly how I felt with him. The procedure was far less painful than I had imagined, and I truly believe that’s because of his skill and the confidence he gives his patients.
The nursing staff was absolutely wonderful
kind, compassionate, attentive, and always there whenever I needed help. Every member of the hospital and hospitality staff treated me with warmth, respect, and genuine care, which made all the difference during my recovery.
It’s rare to find a team that is not only excellent at what they do but also so humane and compassionate. Thank you to Dr. Manish Dubey and the entire team for making my journey so comfortable. I will always be grateful and would wholeheartedly recommend this hospital to anyone looking for exceptional medical care.
Shilpa Nair
4 months ago
I had an excellent experience and am very grateful for the care and support I received. The entire staff was professional, friendly, and attentive, making me feel comfortable throughout the process.
A special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Read moreA special thank you to Dr. Vijaykumar Yadav for his expertise, patience, and compassionate approach. He took the time to explain everything clearly and ensured that all my concerns were addressed. His dedication to patient care is truly commendable.
I highly recommend this place to anyone seeking quality treatment and outstanding service. Thank you once again, Dr. Vijaykumar Yadav, for your exceptional care!
Mahendra Patil
4 months ago
My 3 years 11 month year old daughter was diagnosed with 10 mm kidney stone Dr.A.k.Singhal,Dr.Manish Dubey,and Dr.Ashwita Shenoy performed the surgery to remove the stone on May 30th with immense success. I am deeply grateful for the exceptional care and professionalism demonstrated by this entire team.
From the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Read moreFrom the very beginning,the doctors explained every detail of the treatment process with great patience and clarity, this provided us as parents with immense relief and put our minds completely at ease. The surgery proceeded very smoothly and thanks to the doctors expertise and dedication my daughter is now completely healthy and in excellent health
I would also like to extend my special thanks Dr.A.k. Singhal , Dr. Ashwita Shenoy for providing us with constant support and guidance throughout this entire process.they were always available to answer our questions and ensured that our daughter received the very best treatment . Thank you mitra hospital. Thank you so very much for taking such excellent care of my daughter and for making this difficult time for our family SO much more bearable.
और
मेरी बेटी को left inguinal harniya भी hua था उसकी भी सर्जरी करणी जरुरी थी और DJ स्टेट removal भी करना था june 20 th को मेरे बेटी का Dr. Ashwita Shenoy मॅडम ने left inguinal harniya की surgery बहुत आछी तरह की और DJ स्टेट भी निकाली मेरे बेटी का सब अच्छा हुवा thank you mitr hospital All team thanks Dr. Ashwita Shenoy मॅडम मेरे परिवार के तरफ से आपको और आपके पुरे टीम को धन्यवाद.
excellent treatment my daughter
Thank you mitr hospital
Purva Shingare
4 months ago
Had kidney stone surgery done by Dr Manish Dubey. All staff was cooperative. Doctor Dubey made me so much relaxed that I was not at all worried about the procedure. Other doctors in the OT were also very sweet. The staff is very nice, hospital is clean ,no smell of medicines, housekeeping services are very good. Hospital food is also very nice,tasty and healthy. Insurance procedure is also very easy. The surgery procedure went so smoothly. I would surely recommend Mitr Hospital and special thanks to Dr Dubey.
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Nikita Ghodke
6 months ago
I had an amazing experience at the hospital, which offers excellent facilities and truly stands out in terms of care and support. I was under the treatment of Dr. Vijaykumar Yadav, who is exceptional in his field. His kindness, compassion, and dedication to his work made a significant difference throughout my journey.
He is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Read moreHe is highly detail-oriented and experienced, ensuring I felt confident and well-informed at every step. I underwent two surgeries, and he consistently reassured me and focused on my recovery and well-being. What truly sets him apart is his availability, he was always there whenever needed, even late at night.
Overall, the hospital is outstanding and undoubtedly one of the best in Navi Mumbai. I’m truly grateful for the care I received.
Dimple Choudhary
1 year ago
Very polite staff N great service ☺️
Ketan Bhagat
1 year ago
Excellent,
We had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Read moreWe had a nice experience with Mitr hospital. Dr.A.K.Singal is such a talented Child urologist and nice person. Staff are good. Thank you so much Dr.A.K.Singal sir and Dr.Ashvitha Mam for treating our daughter so well and saving her life.. We w'l be gratful to you throughout our life..
Pankaj Choudhary
1 year ago
Very experienced Doctor and cooperative staff. They give full time to patients for there Query and problems.
Blood test Camp organised for Woman's day was support and very helpful
Read moreBlood test Camp organised for Woman's day was support and very helpful
Sneha Omale
1 year ago
डॉ. अमित घरत इंडॉस्कॉपी खूप छान पध्दती ने केली . धन्यवाद डॉक्टर आणि त्यांची टीम . वेळोवेळी मदत केली बद्दल.
prathamesh palkar
1 year ago
“I am extremely grateful for the excellent service provided by Mr.Aditya Sir from the hospital TPA insurance team. He was incredibly professional, patient, and thorough in explaining my insurance coverage and guiding me through the entire process. His prompt assistance and dedication made everything smooth and hassle-free. I truly appreciate his kindness and efficiency in handling my queries. Thank you, Aditya Sir, for your outstanding support!”
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