The obstruction may cause episodes of loin pain andor nausea and vomiting, urinary infections and kidney stones. Profile and outcome of pelviureteric junction obstruction. Normally, the ureter, a long tube that carries urine from the kidney to the bladder, begins in the kidney with a funnellike structure called the renal pelvis. Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of hydronephrosis. Aug 15, 2018 ureteropelvic junction upj obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 2000 newborns. Puj obstruction with crossing renal vessels a case report. Left kidney is enlarged in size with gross dilation of. Pelviureteric junction puj obstruction is a wellrecognized entity that may present at any time in fetal life, infancy, childhood, or early or late adulthood. Congenital upj obstruction is the most common cause of upper urinary tract obstruction in children by definition, the diagnosis of upj obstruction signifies functionally impaired transport of urine from the renal pelvis into the ureter. Ivpivu has been performed for assessing for puj obstruction.
Your child has right hydronephrosis, which means that there is an obstruction in the urinary tract. Symptoms include flank pain especially with increased fluid intake, urinary tract infections and stones. Imaging in congenital ureteropelvic junction obstruction. This is a condition where the top of the drainage pipe ureter is partly blocked and doesnt allow the urine to drain efficiently. He had the mag3 dye scan at a couple of months and was operated on at 4 months he was also on antibiotics from birth to try and stop any urinekidney infections before surgery which it did in his case sorry probably not very helpful in the context of an older child. Laparoscopic transposition of lower pole vessels for pujo has been described in children as well as adults. Intermittent hydronephrosis due to obstruction of the. Dec 20, 2017 left flank pain due to congenital puj obstruction. On the right contrast pools dependently within a distended renal pelvis, consistent with a puj obstruction.
It is usually present from birth, but may not cause problems until later life. The sensitivity of ivp with furosemide injection in diagnosis of upjo was. Congenitalprimary essentially present since birth as a developmental abnormality. The patient is having pain in abdomen and kidney side. Comparison between diuretic urography ivp and diuretic renography for diagnosis. This is the connection between the renal pelvis and the ureter tube running from the kidney to. Pelviureteric junction obstruction radiology reference article. Mohamed abou elghar, huda refaie, doaa sharaf, tarek eldiasty radiology department, urology and nephrology center, mansoura university, mansoura, egypt abstract. The issue is more pressing if the patient has bilateral obstruction or renal failure due to obstructive uropathy. Your ivp demonstrates evidence that you may still have some obstruction. An xray radiograph is a noninvasive medical test that helps physicians diagnose and treat medical conditions. With the widespread use of antenatal us screening, a genitourinary tract anomaly is detected in 1 of 500 pregnancies. Pdf profile and outcome of pelviureteric junction obstruction. Intravenous urogram ivu showing bilateral puj obstruction.
The etiology of upj obstruction includes both congenital and acquired conditions. Puj obstruction with crossing renal vessels a case report of failed laparoscopic vascular hitch. In this condition there is a blockage of urine at the junction of kidney and the pipe draining ureter pelvi ureteric junction puj. Kidneys were ok and in 20 i had a temp stent in my left kidney for 3 answered by a verified urologist we use cookies to give you the best possible experience on our website. Figure3 showing the percentage of puj obstruction due to crossing vessel and due to intrinsic defect in all of these, anderson hyens pyeloplasty with. Even if puj obstruction is present in birth, symptoms may not occur until later in life. It can present in the newborn as a mass and in the adult with flank pain on hydration, the socalled beer drinkers kidney. Till such time one should use this option carefully. After antenatal us diagnosis the newborn was properly managed postnatally, following current recommendations. In adolescents or adults, puj obstruction can cause pain on in the side of the back, and the pain can be worse after drinking.
This is a highly unusual case of bilateral symptomatic puj obstruction in a neonate, who presented with sudden onset of anuria. Crossing vessels as a cause of pelviureteric junction puj. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography us, intravenous pyelogram ivp, diuretic renography dr, magnetic resonance urography mru and antegrade or retrograde pyelography. Pelviureteric junction obstruction puj is one of the most common congenital abnormalities of the urinary tract. Upj obstruction is the most common congenital malformation of the urinary tract and the most common cause of neonatal and fetal hydronephrosis 1 puv occurs in 1 in every 5,000 to 8,000 boys. Ureteropelvic junction upj obstruction cedarssinai. In some children, there can be a partial block at the puj. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography us, intravenous pyelogram ivp, diuretic renography dr, magnetic resonance urography mru and antegrade or retrograde. There are often associated gastrointestinal symptoms such as nausea and vomiting. Hydronephrosis and puj obstruction kidney disorders. Pelviureteric junction obstruction is a condition caused by a narrowing of the funnelshaped part of the kidney known as the renal pelvis where urine collects before being carried to the bladder by tubes called ureters. Bilateral pelviureteric junction obstruction in a neonate.
Upj obstruction is more commonly 60% found on the left side. Kidney stones or infection may occur in the affected kidney, even after treatment. In the pediatric age group, it is the most common cause of upper urinary tract dilation, accounting for 80% of all dilated collecting systems identified antenatally by fetal ultrasonography. Surgical management of ureteropelvic junction obstruction. A puj obstruction is where there is an obstruction to normal urine flow from the renal pelvis into the ureter. Endopyelotomy for pelviureteric junction obstruction nice. The cause of congenital puj obstruction is incompletely understood but may be as a result of abnormal insertion of the ureter into the renal pelvis, abnormal arrangement of ureteric musculature at the puj or a crossing vessel usually artery running in front of the puj causing an obstruction. Hydronephrosis puj this section discusses about blockage caused by puj obstruction. Ruptured asymptomatic and undetected pelviureteric junction obstruction after trivial abdominal trauma. Laparoscopic pyeloplasty india surgery,laparoscopic. This is producing accumulation of urine and back pressure. An intravenous pyelogram ivp is an xray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins. Radiologic imaging is crucial in diagnosing upj obstruction. Followup after pyeloplasty repair of puj obstruction the dj stent is removed after 68 weeks by cystoscopy under a short sedation at 68 weeks after surgery.
It often happens when a baby is still growing in the womb. However, there are a significant number of people who have this condition that are not discovered until adulthood. Surgical management of ureteropelvic junction obstruction in. Jul 29, 2017 puj obstruction lecture by dr hemant dr. Pelviureteric junction puj obstruction daniel steiner. Ureteropelvic junction upj obstruction may be defined as a functional or anatomic obstruction to urine flow from the renal pelvis to the proximal ureter that results in symptoms or renal damage. A laparoscopic pyeloplasty is a minimally invasive surgical procedure to correct a blockage or narrowing puj obstruction of the junction of the kidney to the tube draining urine. This is called a puj pelviureteric junction obstruction. Laparoscopic pyeloplasty, puj obstruction in right kidney, stent inside.
This compresses a part of the kidney and dilates the pelvis portion of the kidney. Ureter anatomy the ureters are bilateral tubular structures responsible for transporting urine from the renal pelvis to the bladder. Gross hydronephrosis with no residual cortical tissue puj obstruction not multicystic dysplastic kidney as has it maintains a reniform shape. Dec 20, 2015 radiologic imaging is crucial in diagnosing upj obstruction. This can be due to a number of conditions, including congenital abnormalities of the ureter muscles, unusually located blood vessels that block the path of the ureter, or scarring from previous. Stent in ureter but that was negated by another doctor. Docter found a small stone in kidney but told that this is very small and not be a factor for. Ureteropelvic junction upj obstruction is a condition where the ureter, the tube that connects the kidney to the bladder, is blocked at the top portion where it leaves the kidney.
My son had a puj obstruction but it was from birth. On the delayed excretory phase images, the kidneys behavior differently. It may be attributed to functional or anatomical abnormalities, or there may even be an association between them. Wiley online library will be unavailable on saturday 7th november 2015 from 10. If untreated, upj obstruction can lead to permanent loss of kidney function kidney failure.
Pelviureteric junction obstruction this%information%sheet%is%for%educational%purposes%only. Acucise endopyelotomy is a very well respected treatment option. This dilatation of the collecting system is referred to as hydronephrosis. Ruptured asymptomatic and undetected pelviureteric. In aryans case, the ec scan confirms the presence of right hydronephrosis. On the left the calyces are outlined, compressed by numerous parapelvic cysts which do not contain contrast. Pelviureteric junction puj obstruction is a partial or total blockage of the flow of urine that occurs where the ureter enters the kidney and is the most common cause of significant dilatation. At the junction of the renal pelvis where urine is collected after being produced by the kidney and the ureter the connecting tube between kidney and bladder there can be a blockage. Parapelvic cysts and puj obstruction radiology case.
The best test to determine that your surgery was successful is called a renal scan. Congenital puj obstruction dj stent doctor answers on. It can cause chronic or recurrent flank pain as well as urinary tract infections. I had an upj obstruction in left side owing which i had back pain and nausea doctors in 1998 through an open pyeloplasty attempted to remove the obstruction but on follow up in ivp obstruction was still seen. My age is 38 yearsread more left flank pain due to congenital pelviureteric junction puj obstruction, is surgery needed.
What are the symptoms or features of puj obstruction. Often it affects one side alone although it can involve both kidneys. Puj obstruction with crossing renal vessels a case. The degree of obstruction is significant as there is definite delay in clearance of the isotope. A child should be followed up for at least several years after a pyeloplasty. Ultrasound is done after about a month of stent removal and a renal scan 34 months later. Out of 27 patients who were operated in urology department for puj obstruction, 5 18.
With the advent of prenatal ultrasound it is often diagnosed prior to birth. Ureteropelvic junction upj obstruction is a partial or intermittent total blockage. Ct ivp technique ie preliminary injection of 30 mls and delay of 20 mins followed by renal parenchymal phase using 70 mls of contrast. Indications of back pain or pain in the flanks the. Ureteropelvic junction obstruction upjo is one of the most common causes of urinary tract obstruction in children. The good news from the scan is that the renal functions are preserved. Puj obstruction and laparoscopic pyeloplasty patient information marc e laniado md frcsurol febu consultant urological surgeon page 3, revision date. Ureteropelvic junction upj obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 2000 newborns.
The intravenous pyelogram ivp revealed hydronephrosis and a dilated. For many years, intravenous urography ivu was the modality of choice for diagnosing urinary tract abnormalities. Pelviureteric junction obstruction is the most common. A upj obstruction can also occur if a blood vessel is positioned incorrectly over the ureter. Ivp and diuretic renography for diagnosis of ureteropelvic. Upj obstruction is the most common pathologic cause of antenatally detected hydronephrosis. On the left the calyces are outlined, compressed by numerous. Ureteropelvic junction obstruction occurs when the connection between ureter and kidney is narrowed, or blocked completely. In all the patients who have symptoms along with documented obstruction one should attempt to salvage the kidney. Pelviureteric junction puj obstructionstenosis, also known as ureteropelvic junction upj. Ureteropelvic junction upj obstruction is a blockage at the point where part of the kidney attaches to one of the tubes to the bladder ureters. The puj is the point at which the renal pelvis joins the ureter.
There are several treatment modalities available for upj obstruction. Ureteropelvic junction upj obstruction is a partial or intermittent total blockage of the flow of urine that occurs where the ureter enters the kidney. A rare cause of ureteropelvic junction obstruction ncbi. Contents embryology incidence etiology pathogenesis diagnosis surgical management 3. Crossing vessels as a cause of pelviureteric junction. They are generally 22 to 30 cm in length with a wall composed of multiple layers. Docter found a small stone in kidney but told that this is very small and not be a factor for hydronephrosis. Ureteral obstruction mimicking parapelvic cystsa case of. If the transition from the renal pelvis to the ureter is narrow, the urine will not drain easily and backs up causing dilatation of the collecting system proximal to that point and enlargement of the renal pelvis. Before embarking upon the surgery, there are certain important issues which need to be sorted out. Ureteropelvic junction upj obstruction occurs when the area connecting the renal pelvis part of the kidney to one of two tubes that connect with the bladder ureter becomes blocked, causing urine to build up, which damages the kidneys.
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