Pelviureteric Junction Obstruction (PUJ): Causes, Symptoms & Treatment Guide

Pelviureteric Junction Obstruction (PUJ) is also known as Ureteropelvic Junction Obstruction (UPJ). This is a condition in which the urine flow from the kidneys to the bladder is partially or completely blocked.

PUJ may occur for various reasons; it can affect both children and adults. Prolonged or untreated blockage can lead to major kidney problems like kidney swelling, hydronephrosis, and even kidney damage.

Did you know that Pelviureteric Junction Obstruction is the major and most common cause of congenital hydronephrosis (Hydronephrosis since birth). 

According to a study published in Wolters Kluwer, ureteropelvic junction obstruction affects about 1 in 500 to 1500 newborns.

PUJ is more common in baby boys than in girls. NCBI study reveals a gender ratio of 3-4:1.

The frequency of the left side getting affected is higher than the occurrence in the right side.

Approximately 10-40% cases are bilateral.

PUJ is usually present at birth because of inadequate recanalisation (no opening) of the ureter during the development stage.

It is quite rare that adults acquire PUJ, but it can be treated with timely intervention. You can see improved outcomes with early detection and treatment. 

It might sound scary with all the numbers and long-term effects. But do not worry, you are not alone. We make sure you regain better health with the right medical care.

At NU Hospitals, our expert team of pediatric and general urologists are specialised in treating PUJ obstruction with advanced surgical techniques like Laparoscopy and Robotic-assisted systems.

This article helps you understand about pelviureteric junction obstruction, its causes, symptoms to look out for and when you should seek medical help.

Read on and find out how NU Hospitals, Bangalore, helps patients like you regain a quality of life.

PUJ in Children vs Adults: Key Differences and Risks

The causes, symptoms, and treatment vary for both children and adults with PUJ obstruction. Depending on the age, PUJ obstruction presents differently.

 Dear parents, remember that early detection can help your child by preserving kidney function. The damage can be prevented, and they can have a better quality of life.

Elder patients should also get evaluated for kidney stones, UTIs and unexplained flank pain.

Early Signs and Symptoms of Pelviureteric Junction Obstruction

With early detection of warning signs and symptoms of UPJ obstruction, you can prevent many long-term complications.

A few common early signs and symptoms of PUJ obstruction include:

• Flank pain

• Discomfort in the abdominal region

• Recurrent UTIs

• Nausea

• Vomitting

• Abdominal bulging in pediatric cases

• Blood in urine

• Poor growth in children

Diagnosis of PUJ: Tests, Imaging, and Latest Technologies

PUJ obstruction can be diagnosed with clinical evaluation, imaging and functional tests. Our experts would recommend:

• Ultrasound

An ultrasound of the kidneys and ureter will be done to detect swelling of the kidney (hydronephrosis)

• Renal Scan

Diuretic renography is a kidney scan that measures kidney function and urine drainage. This scan helps in understanding the severity of the obstruction.

• CT/MRI Urography

For complex cases when ultrasound is not enough, a CT or an MRI will be suggested for detailed imaging. (Rarely done)

• Blood Test

Blood tests are done to check for kidney function

• Urine Test

To check for any infection

• Intravenous Pyelogram

This is a traditional method of imaging for complex cases. This is rarely used to visualise obstruction and kidney function.

Treatment Options for PUJ: Surgical and Non-Surgical Approaches

The treatment options vary based on the severity of the obstruction, age of the patient, and the symptoms.

A few significant treatment options include:

1. Non-surgical Management

For minor asymptomatic cases with normal kidney function. Involves medication for infections, regular monitoring and lifestyle modifications. You would be advised to get regular renal scans to track any progression.

2. Surgical Management

Surgery is recommended when there is significant obstruction, kidney damage and recurrent UTIs

• Open Pyeloplasty

It is a traditional method of surgery. A direct incision is made to remove the obstruction and reconstruct the tract.

• Laparoscopic Pyeloplasty

A minimally invasive laparoscope is used for the surgery. Used for older children and adults.

• Robotic Pyeloplasty

Modern robotic-assisted surgeries offer better precision, minimal scarring and faster healing.

Recovery from PUJ

Minimally invasive procedures offer:

• Less pain

• Shorter hospital stay

• Quick recovery

• High precision

• Minimal scarring/trauma

• Faster healing

Children usually stay for 2-5 days and can see full recovery in 4-6 weeks. While adults might stay for 2-7 days and can return to normal activity within 4 weeks after an open pyeloplasty.

Potential Complications from Untreated PUJ

Untreated PUJ obstruction can cause many complications to your health, including:

• Progressive kidney damage

You might lose kidney function over the long run and potentially incur irreversible kidney damage.

• Chronic hydronephrosis

Swelling of the kidneys, fluid retention can lead to kidney scarring.

• High blood pressure

With low kidney function, the blood pressure can be elevated leading to hypertension.

• Recurrent UTIs

Refluxes and obstruction in the long run can cause recurrent UTIs.

• Kidney Stones

Stones can be formed in the obstructed kidney.

Do not worry, we are here to help you with early detection and prompt treatment, reducing the risk of long-term kidney complications. 

When to Seek Medical Help for Pelviureteric Junction Obstruction

You should consult with a urology specialist if you or your child is facing the below symptoms:

• Severe abdomen/back/flank pain

• Recurrent UTIs

• Blood in urine

• Abdominal swelling (in kids/infants)

• Poor growth (in kids)

• Unexpected weight loss in children

Latest Advances in PUJ Care and Management

Modern advancements in Urology and surgical techniques include

• Robotic-assisted pyeloplasty

• 3D imaging

• Intraoperative guidance

• Minimally invasive surgery (Laparoscopic)

At NU Hospitals, Bangalore (Bengaluru), we have all the modern equipment backed by the global expertise of our urology specialists. Do not worry, your health is in safe hands.

Choose NU Hospitals for Expert PUJ Treatment and Care

As the most trusted hospital for all nephrology and urology concerns, our patients benefit from:

• Renowned Team of Experts with a Multi-Disciplinary Approach (Pediatric and general urologists and nephrologists)

• Exceptional Care and World-class Technology (including advanced robotic and laparoscopic surgeries)

• Expert pediatric and adult urologists with decades of global experience

• Compassionate care tailored to every patient

• No. 1 Hospital for PUJ Obstruction management in India and Bangalore

• Pioneers in Pyeloplasty Surgery

• Legacy of Innovation and Trusted by Millions

• Protocolized Evidence-based Care

Bangaloreans can now access world-class urology care at the heart of Rajajinagar, Padmanabhanagar and surrounding areas.