What is a blockage at the Pelvi-Ureteric Junction in children?

The kidneys' main job is to filter the blood and create urine (waste). This urine travels from the kidney into a funnel-like area called the renal pelvis, then flows through a connection called the Pelvi-Ureteric Junction (PUJ) into a tube called the ureter, which leads to the bladder.

In some children, there is a blockage at this junction. This blockage can be "high grade" (severe), "low grade" (mild), or "intermittent" (happening only sometimes). If left untreated, this blockage causes urine to back up, making the kidney swell and potentially causing it to lose function over time.

What are the signs that a child has a PUJ blockage?

Most often, the blockage is caused by a problem with how the muscles at the junction developed before birth. This prevents urine from draining properly.

• Before Birth: Many cases are found during pregnancy via a prenatal ultrasound. If the kidneys look enlarged, it is called fetal hydronephrosis.
• Older Children: Older kids might experience pain in their side or back, urinary tract infections (UTIs) caused by stagnant urine, or kidney stones. If an infection occurs alongside a long-term blockage, it can permanently damage the kidney.

What causes a PUJ obstruction in children?

In most cases, the condition is a "birth flaw," meaning the child was born with a junction that is too narrow. While the problem exists from birth, the symptoms may not appear until later in childhood when the kidneys begin to produce more urine.

In older children, the blockage can sometimes be caused by a "crossing vessel." This is a blood vessel that accidentally presses against the junction, pinching it shut. In these cases, the pain and symptoms may come and go depending on how much urine the kidney is producing.

How do doctors find a PUJ blockage in children?

Doctors use two main tests to diagnose this condition:

1. Ultrasonography (Ultrasound): A basic screening tool that shows the doctor how much the kidney is swollen (hydronephrosis).
2. Diuretic Renal Scan (DRS): A specialized scan used to see how well each kidney is functioning and how quickly urine is actually moving through the junction.

How do doctors treat a PUJ obstruction in children?

The goal of treatment is to relieve pain, clear infections, and prevent permanent kidney damage caused by high pressure.

Not every child with a blockage needs immediate surgery. A pediatric urologist (a specialist doctor) will monitor the child to see if the blockage gets worse. However, surgery is usually required if:

• The kidney is not draining well.
• The child is in constant pain.
• The child has frequent urinary tract infections.

During the surgery, the doctor removes the narrow/blocked part of the tube and reattaches the healthy part of the ureter to the renal pelvis. If a blood vessel is causing the pressure, the doctor will reposition the tube to clear the path.

How is a Pyeloplasty surgery performed on children?

A Pyeloplasty is the name of the operation used to fix the blockage. Before the surgery, the doctor may perform a special X-ray called an RGP while the child is asleep to confirm the exact location of the block.

There are two main ways to perform this surgery:

• Open Surgery: The doctor makes a small cut on the child’s side or back to reach the kidney.
• Laparoscopic (Keyhole) Surgery: The doctor uses a camera and small tools through tiny cuts in the belly. This method is technically difficult in babies under one year old due to limited space, but for older children, it offers a faster recovery, less pain, and very small scars. This should only be performed by a highly skilled doctor.

How are children cared for after a Pyeloplasty surgery?

After the surgery, a small tube called a DJ stent is often left inside to help the area heal.

• Stent Removal: About 6 to 8 weeks after surgery, the doctor removes the stent during a quick procedure while the child is under short-term sleep.
• Follow-up Scans: An ultrasound is usually done one month after the stent is removed, followed by a kidney scan 3 to 4 months later.
• Long-term Monitoring: A child should be monitored for several years. It is important to note that even after a successful surgery, an ultrasound may still show some swelling. This is normal, as the kidney "funnel" may stay stretched even after the blockage is gone. The doctor will use a renal scan to confirm that urine is flowing correctly and the kidney is healthy.

Why choose Tender Palm Super-Speciality Hospital for Pelvi-Ureteric Junction Obstruction (PUJO) treatment for children in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Pelvi-Ureteric Junction Obstruction (PUJO) treatment for children in Lucknow, India, at an affordable cost. We have a team of experienced pediatric urologists and kidney specialists who provide accurate diagnosis with advanced imaging, personalized medical care, and minimally invasive surgical treatment tailored to each child's specific condition. Our Pediatric Urology team has decades of experience in successfully treating Pelvi-Ureteric Junction Obstruction (PUJO) in Lucknow, India.

To seek an Expert Consultation for Pelvi-Ureteric Junction Obstruction (PUJO) treatment for children in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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