The video clip demonstrates transperitoneal pyeloplasty in a 3 year old girl. Any untreated obstruction to the developing renal tract can lead to irreversible damage to the developing kidneys and accounts for 25% of chronic renal failure seen in childhood. This article discusses the surgical management of this condition alongwith the pathogenesis, clinical presentation, and diagnosis of puj obstruction. Because the obstruction is affected by blood flow the problem might stop and start, depending on how much blood is going through the vessel. Pujo can be diagnosed during investigation of urological symptoms, or imaging for other reasons. An uncommon cause of puj obstruction and hydronephrosis. But what happens when the area where the ureter and the renal pelvis meet becomes blocked in children. Ureteropelvic junction obstruction urology experts. Hydronephrosis puj this section discusses about blockage caused by puj obstruction.
Pelvi ureteric junction obstructionpujo treatment nu. They are generally 22 to 30 cm in length with a wall composed of multiple layers. Urological disorders in children that progress to chronic. Laparoscopic pyeloplasty for repair of pelviureteric junction. We report a case of puj obstruction due to cystic ureteritis that had been diagnosed during. Mar 19, 20 against this backdrop, we aimed to describe the national use and in. How will you diagnose and manage a case of puj pelviureteric junction obstruction. Gross hydronephrosis with no residual cortical tissue puj obstruction not multicystic dysplastic kidney as has it maintains a reniform shape.
The young age and lack of any history of renal trouble suggest that the case is congenital puj obstruction ideally this diagnosis should be confirmed with either an ivu or nuclear imaging study to dynamically confirm a puj obstruction. Congenital pelviureteric junction obstruction radiology. Additionally, secondary puj obstructions may occur after endoscopic or open urinary tract procedures. In this condition there is a blockage of urine at the junction of kidney and the pipe draining ureter pelvi ureteric junction puj. Pediatric ureteropelvic junction obstruction treatment. Pelviureteric junction obstruction this%information%sheet%is%for%educational%purposes%only. The overall incidence of puj obstruction caused by lower pole crvs was 18. Pelviureteric junction obstruction radiology reference.
Less commonly, the obstruction is caused by a blood vessel which crosses the renal pelvis, causing a blockage. Pelviureteric junction puj obstruction is a restriction to the flow of urine from the renal pelvis to the ureter, which if left uncorrected, may lead to progressive renal deterioration. Exported calyceal rupture due to acute ureteric obstruction. Helical computed tomography ct was used to demonstrate the distribution of crossing vessels in patients with ureteropelvic junction upj obstruction for planning surgical management. Giant hydronephrosis due to pelviureteric junction obstruction. The incidence of upj obstruction is less well defined in adults than in children. The most common etiology of renal forniceal rupture is obstruction caused by distal ureteric stones followed by malignant extrinsic ureteric compression. On the basis of a series of cases that were referred to the authors in their clinical practice, they found that the unprecedented quality and novel perspectives of multidetector row computed tomography ct with two and threedimensional postprocessing. The blockage slows or stops the flow of urine out of the kidney.
Left kidney shows retention of activity in the clearance phase which does not respond to iv furosemide. This dilatation of the collecting system is referred to as hydronephrosis. Which surgery is best for patients with puj obstruction in. Puj obstruction and laparoscopic pyeloplasty patient information marc e laniado md frcsurol febu consultant urological surgeon page 3, revision date. Widespread use of antenatal ultrasonography and the advent of modern imaging techniques have resulted in earlier and more common diagnosis of hydronephrosis. Aug 29, 2006 apart from lithiasic obstructive pathology itself quite rare in children and trauma, the occurrence of a urinoma is a rare event in pediatric practice, and is strongly associated with the existence of a urinary obstruction, such as posterior urethral valves puv or ureteropelvic junction obstruction upjo 4. The blockage is always partial but the degree of a block may vary from minimal to severe. Dec 20, 2015 radiologic imaging is crucial in diagnosing upj obstruction. Ureterocalicostomy is a wellestablished procedure of choice for recurrent pelviureteric junction puj obstruction refractory to endoscopic management, failed pyeloplasty, completely intrarenal pelvis, and iatrogenic upper ureteral stricture with significant peripelvic fibrosis. This scan can be useful in the workup of renal masses, painless haematuria and causes of obstruction eg pyeloureteric junction puj obstruction. 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. Upper ureteric stricture secondary to celiac plexus block.
This article focuses on congenital and acquired causes of renal tract obstruction including posterior urethral valves puv, pelviureteric junction puj obstruction, prune belly syndrome, neuropathic bladder and. Congenital puj obstruction dj stent doctor answers on. This is where the kidney attaches to one of the ureters the tubes that carry urine to the bladder. Crossing vessels as a cause of pelviureteric junction puj. It can be congenital or acquired with a congenital puj obstruction being one of the commonest causes of antenatal hydronephrosis. Feb 17, 2014 the video clip demonstrates transperitoneal pyeloplasty in a 3 year old girl. 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. Ureteropelvic junction obstruction upjo is a benign, congenital condition that remains an enigma in terms of both diagnosis and therapy. Ct ivp technique ie preliminary injection of 30 mls and delay of 20 mins followed by renal parenchymal phase using 70 mls of contrast. It may be attributed to functional or anatomical abnormalities, or there may even be an association between them. Ct of the abdomen is a portal venous phasecontrast ct performed while the patient is supine. Endopyelotomy for pelviureteric junction obstruction nice. The national institute for health and clinical excellence nice has issued full guidance to the nhs in england, wales, scotland and northern ireland on.
The authors describe a novel operative technique in a child with puj obstruction in a horseshoe kidney, where a pyeloplasty was clinically indicated but unsafe because of insufficient length of ureter and predicted technical difficulty in transposing large renal vessels coursing to the renal hilum. Crossing vessels as a cause of pelviureteric junction puj obstruction muhammad irfan munir, ashraf ali jafari, ghulam mahboob subhani, safdar hassan javed, akhlaq ahmed, zahid iqbal ml of lignocaine plain while introduction pelviureteric junction obstruction is the most common cause of significant dilatation of foetal kidneys. Imaging of puj obstruction pujo includes renal ultrasonography us, ivu, diuretic renal scintigraphy and retrograde ureteropyelography. Other causes are pelvicureteric junction puj obstruction, vascular extrinsic compression, iatrogenic and i. One week later, antegrade and retrograde radiograph studies demonstrated complete obstruction of both ureters at the level of the ureteropelvic junction. Often it affects one side alone although it can involve both kidneys. Imaging in congenital ureteropelvic junction obstruction. Pelviureteric puj obstruction is the name given to a condition in which the flow of urine from the kidney is slowed down leading to pain in the back. On the basis of a series of cases that were referred to the authors in their clinical practice, they found that the unprecedented quality and novel perspectives of multidetector row computed tomography. Please click the links on the left to find out more about the condition and the operation to fix it. Dec 16, 2009 the national institute for health and clinical excellence nice has issued full guidance to the nhs in england, wales, scotland and northern ireland on endopyelotomy for pelviureteric junction obstruction. This is called a puj pelviureteric junction obstruction.
Pelviureteric junction puj obstruction stenosis, also known as ureteropelvic junction upj obstruction stenosis, can be one of the causes of obstructive uropathy. Magnetic resonance imaging in the evaluation of pelvi. A new operative technique extra renal ureterocalycostomy. It is thought that in the absence of infectious complications that pujo in adults is a benign condition. For those with impaired function of the affected renal unit, the situation is less clear, with pyeloplasty. Thus, we were able to make a firm diagnosis of bilateral puj obstruction from blunt trauma. Using the 20042008 nationwide inpatient sample nis, we identified 4590 paediatric patients who underwent pyeloplasty for puj obstruction.
Aug 15, 2018 ureteropelvic junction upj obstruction is by far the most common cause of pediatric hydronephrosis, occurring in 1 per 2000 newborns. However, amongst symptomatic children the proportion of those with puj obstruction caused by extrinsic pressure from crv was significantly higher, reaching 3050%8, 12. Ureter anatomy the ureters are bilateral tubular structures responsible for transporting urine from the renal pelvis to the bladder. This file contains additional information such as exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it. 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. Ureteropelvic junction upj obstruction is when part of the kidney is blocked. If the address matches an existing account you will receive an email with instructions to reset your password. The aim of this study was to report our initial experience with laparoscopic pyeloplasty lp in children with pelviureteric junction puj obstruction and describe the evolution and evaluate the results. Laparoscopic pyeloplasty india surgery,laparoscopic. Delayed bilateral ureteropelvic junction obstruction from. It is not a recommended test for initial investigation of suspected renal colic. Apr 29, 2011 pelvi ureteric obstruction in one day old girl. Evaluation of crossing vessels in patients with ureteropelvic. Racgp urolithiasis ten things every general practitioner.