WHAT IS PUJ OBSTRUCTION?
PUJ obstruction, often termed “Pelvi-Ureteric Junction Obstruction,” represents a medical anomaly in the urinary pathway. This particular condition manifests when there’s an impediment or hindrance to the urine’s flow at the point where the kidney’s funnel-like section, known as the renal pelvis, connects with the ureter — the channel responsible for transporting urine from the kidney down to the bladder.
HOW DO WE DIAGNOSE PUJ OBSTRUCTION?
The diagnosis of Pelvi-Ureteric Junction (PUJ) obstruction is primarily based on imaging studies. Here’s a detailed look at how PUJ obstruction is diagnosed:
1. History and Physical Examination:
· Initial evaluation begins with a thorough history-taking to identify any symptoms like flank pain, recurrent urinary tract infections, or blood in the urine.
· A physical examination might reveal a palpable mass (enlarged kidney) or tenderness in the flank area.
· This is usually the first imaging study done when PUJ obstruction is suspected.
· An ultrasound can denote the swelling of the kidney which is also called hydronephrosis and it happens due to urine’s buildup. This is a common indication of possible obstruction.
· It’s non-invasive, doesn’t use radiation, and provides a good initial assessment of the kidney’s size, shape, and any signs of blockage.
3. Intravenous Pyelogram (IVP):
· In this test, a dye (contrast) is injected into a vein, and a series of X-rays are taken to observe the flow of the dye through the kidneys, ureters, and bladder.
· Any obstruction or blockage can be identified as the dye will not flow normally past the point of obstruction.
4. Diuretic Renal Scan (DRS):
· This involves the injection of a radioactive substance and a diuretic (to increase urine production).
· This test provides information about the function of each kidney and can identify a functional obstruction at the PUJ, even if anatomical studies like ultrasound or CT are inconclusive.
5. Computed Tomography (CT) Scan:
· A CT scan helps get a detailed image of the urinary tract.
· When done with contrast, it can provide valuable information about the site and cause of the obstruction.
· It can also detect other abnormalities or complications like infections or even kidney stones.
6. Magnetic Resonance Urography (MRU):
· MRU helps visualize the urinary tract.
· It provides detailed images and can be particularly useful when other tests are inconclusive or when there’s a need for more detailed anatomical information.
7. Retrograde Pyelography:
· This is an invasive test where a contrast dye is directly injected into the renal pelvis through a catheter placed via the bladder and ureter.
· X-rays are then taken to visualize the anatomy and location of the obstruction.
Once the diagnosis is made, the severity of the PUJ obstruction and its impact on kidney function will guide the subsequent management decisions, which could range from observation to surgical intervention.
SYMPTOMS OF PUJ OBSTRUCTION:
· Flank Pain: One of the most common symptoms is pain in the flank or side, typically due to the distension of the renal capsule from accumulated urine.
· Haematuria: Blood in the urine can at times denote PUJ obstruction, although there could be other causes as well.
· Urinary Tract Infections (UTIs): Recurring UTIs can sometimes occur because of the pooling of urine above the obstruction.
· Palpable Mass: In some cases, especially in infants, a swollen kidney can be felt through the abdominal wall.
· Poor Growth in Infants: Babies with significant PUJ obstruction might not grow at the expected rate.
· Vomiting and Feeding Difficulties in Infants: Babies can also exhibit these symptoms due to PUJ obstruction.
CAUSES OF PUJ OBSTRUCTION:
· Congenital Abnormalities: The most common cause of PUJ obstruction is a congenital defect, meaning it’s present at birth. The exact reason for this developmental issue isn’t always known.
· Vascular Causes: Sometimes, an abnormal blood vessel can compress the PUJ, leading to obstruction.
· Scar Tissue: Previous surgeries, trauma, or infections can cause scar tissue to form, leading to obstruction.
· Adhesions: Sometimes, after abdominal surgery, adhesions (bands of scar-like tissue) can form and cause an external pressure on the PUJ, leading to obstruction.
· Tumors or Cysts: Rarely, masses such as tumors or cysts can cause external compression, leading to PUJ obstruction.
· Functional Defects: In some cases, there might not be any physical blockage, but the peristaltic waves (muscular contractions) of the ureter that propel urine forward are not effective at the PUJ, causing a functional obstruction.
· Hydronephrosis: Urine buildup can cause the kidneys to swell.
· Kidney Damage: Prolonged obstruction can harm kidney structures and function.
· Recurrent UTIs: Stagnant urine can lead to repeated infections.
· Kidney Stones: Stagnation may promote stone formation.
· Kidney Atrophy: Persistent obstruction can cause the kidney to shrink.
· Renal Failure: In severe, untreated cases, loss of kidney function can occur.
· Hypertension: Reduced kidney function can lead to high blood pressure.
· Pain: Chronic pain or discomfort in the flank or side.
BEST TREATMENTS FOR PUJ OBSTRUCTION
Some of the best treatment for PUJ Obstruction are as follows
· Observation: For mild cases without symptoms.
· Pyeloplasty: Surgical procedure to remove the obstruction and reconstruct the PUJ.
· Endopyelotomy: An incision is made in the narrowed part using a special instrument or laser, usually via a scope.
· Laparoscopic Pyeloplasty: Minimally invasive surgery to correct the obstruction.
· Robotic-assisted Laparoscopic Pyeloplasty: Using robotic assistance for precision during the minimally invasive procedure.
· Balloon Dilation: A balloon is used to dilate the narrowed area, typically under fluoroscopic guidance.
· Stenting: Placement of a ureteral stent to bridge the obstructed segment, usually temporary.
· Percutaneous Nephrolithotomy (PCNL): For associated kidney stones.
In light of the potential risks associated with PUJ obstruction, it’s crucial for individuals to be attentive to any unusual symptoms and seek medical intervention early. For those in the Ahmedabad region, Devasya Hospital stands as the best hospital for PUJ obstruction. Recognized for its expertise in handling PUJ obstructions, the hospital boasts an exceptional team of professionals equipped with profound knowledge and experience in the field. Coupled with its state-of-the-art infrastructure, Devasya Hospital ensures that patients receive the highest standard of care, fostering quicker recoveries and better overall outcomes. Investing in one’s health is paramount, and choosing a reputable institution like Devasya Hospital is a step in the right direction.