What is PUJ obstruction?
The pelviureteric junction (PUJ) is the natural connection between the kidney and the ureter, the tube that carries urine to the bladder. If this connection becomes narrowed, urine flow can become restricted, causing urine to back up and collect within the kidney.
The condition can be present from birth or develop later in life. It may cause symptoms, or be found unexpectedly on a scan.
Symptoms
PUJ obstruction may cause the following symptoms:
- Intermittent pain in the side or loin, often after fluids
- Recurrent urinary infections
- Blood in the urine
- Sometimes no symptoms at all
How it is diagnosed
Diagnosis of a PUJ obstruction usually involves imaging tests such as an ultrasound or CT scan to assess the appearance of the kidney and identify any swelling caused by impaired drainage. A specialised nuclear medicine test called a radioisotope renogram is also often performed. This provides important information about how well urine is draining from the kidney, and also measures the individual contribution of each kidney to your overall kidney function. These results help determine whether treatment is required and, if so, which approach is most appropriate.
Treatment
If a PUJ obstruction is causing significant symptoms, affecting kidney function, or leading to worsening drainage, treatment may be recommended. The most effective surgical option is usually a robotic pyeloplasty. This minimally-invasive keyhole procedure removes the narrowed or blocked section and carefully reconstructs the connection between the kidney and ureter, allowing urine to drain normally again.
Robotic pyeloplasty offers excellent long-term results, with success rates consistently above 90%. The benefits of robotic surgery include smaller incisions, reduced pain, a quicker recovery, and a high likelihood of preserving kidney function.