What Is PUJ Obstruction?

PUJ Obstruction, also known as Pelvi-Ureteric Junction Obstruction, refers to a blockage at the junction where the kidney meets the ureter (the tube that carries urine from the kidney to the bladder). This blockage restricts the normal flow of urine, causing urine to back up into the kidney, which can lead to swelling (hydronephrosis) and, over time, kidney damage.

PUJ obstruction can be:

  • Congenital: Present at birth due to developmental abnormalities.

  • Acquired: Due to inflammation, scarring, kidney stones, or compression from external structures.

Diagnosis

Diagnostic approaches include:

  • Ultrasound (most common initial test): Identifies swelling (hydronephrosis) in the kidney.

  • CT Scan (Computed Tomography): Provides detailed imaging of obstruction and surrounding structures.

  • MAG3 Renal Scan (nuclear medicine scan): Evaluates kidney function and identifies the severity of blockage.

  • Intravenous Pyelogram (IVP): X-ray imaging after injecting dye, assessing the urinary tract function and anatomy.

Symptoms

Symptoms vary depending on severity and age:

Infants and young children:

  • Abdominal swelling or mass

  • Recurrent urinary tract infections (UTIs)

  • Poor feeding or irritability

  • Delayed growth (failure to thrive)

Older children and adults:

  • Intermittent flank (side) or abdominal pain, especially after drinking fluids

  • Nausea and vomiting

  • Blood in the urine (hematuria)

  • Recurrent UTIs

  • Kidney stones

Some individuals, especially those with mild obstruction, may have no symptoms.

Treatments

Treatment choice depends on severity, symptoms, and kidney function. Options include:

Observation (for mild or asymptomatic cases):

  • Regular imaging (ultrasounds or renal scans) to monitor kidney health.

Surgical correction (common for symptomatic or significant blockage):

  • Pyeloplasty: Most common and effective treatment. Surgery to remove the obstructed portion and reconstruct the PUJ.

    • Open surgery: Traditional approach, larger incision.

    • Laparoscopic or robotic-assisted surgery: Minimally invasive, quicker recovery, shorter hospital stays.

  • Endoscopic treatments (less common): Internal balloon dilation or insertion of stents to relieve obstruction temporarily or in selected cases.