PUJ OBSTRUCTION - PYELOPLASTY

Q.What is PUJ obstruction?

The urine formed in the kidney collects in the kidney pelvis. This pelvis is connected to the bladder by a tube called the ureter. Sometimes there is obstruction at the junction of the kidney's pelvis and ureter. If the obstruction is complete, the function of the kidney will be seriously affected. The obstruction can be present at the time of birth or later, at any age. The commonest age of presentation is early in adult life

The cause of obstruction is usually a developmental defect of the muscle in this region. It can be due to other causes also, such as an abnormal kidney artery in this region producing mechanical obstruction.

How is it treated?

The treatment is by surgery. This can be done either by open surgery, with its accompanying morbidity of a 15 cm wound or in some cases, by endoscopic techniques ( endopyelotomy).

By far, the best results are obtained by open surgical techniques. Now laparoscopy can do the same repair with the same results but avoiding all the morbidity of the open surgical wound and is considered by many Urologists as the gold standard

Steps of repair:

While open surgery requires either a large abdominal or flank incision, minimally invasive approaches involve 3-4 keyhole incisions in the abdomen. Most patients with adrenal tumors who are candidates for open surgery are also excellent candidates for a robotic / laparoscopic approach. These minimally invasive approaches have become the standard of care for most adrenal tumors.

Patients with very large tumors or tumors invading surrounding structures e.g. vena cava, kidney, liver, bowel may be best served by an open approach due to the extent and need for adjacent organ resection.