Pelvi-Ureteric Junction Obstruction (PUJO) is a condition where there is a blockage at the junction where the kidney pelvis connects to the ureter, which carries urine to the bladder. This results in a build-up of urine within the kidney, known as **hydronephrosis**, leading to kidney swelling or fullness. Dr. Pruthvi Raj Honnaiah, an experienced paediatric urologist, offers expert diagnosis, evaluation, and surgical correction of PUJO to restore normal kidney drainage and prevent long-term kidney damage in children.

What is PUJO?

PUJO occurs when a partial or complete blockage at the point where the kidney pelvis meets the ureter prevents urine from draining normally. This obstruction can occur on one or both sides and may be detected during prenatal ultrasound or after birth when symptoms develop.

Left untreated, PUJO can cause:

• Kidney swelling (hydronephrosis)
• Recurrent urinary tract infections (UTIs)
• Pain in the abdomen or flank (side)
• Gradual loss of kidney function

Causes and Risk Factors

PUJO is usually **congenital** (present at birth), caused by abnormal development of the ureter. In some cases, it can develop later due to:

• Abnormal blood vessels crossing the ureter
• Scarring from prior infections or trauma
• Compression by nearby structures

It may occur in isolation or alongside other congenital kidney anomalies.

Symptoms and Signs

Symptoms vary depending on the severity of obstruction and age of the child. Common signs include:

• Abdominal or flank pain
• Urinary tract infections (UTIs)
• Poor feeding or irritability in infants
• Vomiting or failure to thrive
• Blood in the urine (hematuria)
• Detectable swelling of the abdomen in severe cases

Many cases are detected through prenatal ultrasound showing **hydronephrosis** before birth.

Evaluation and Diagnosis

Comprehensive evaluation is essential to confirm PUJO and assess kidney function. Diagnostic tests may include:

• Ultrasound: To detect kidney swelling (hydronephrosis).
• Renal Scan (DTPA or MAG3): To measure how well each kidney is functioning and assess the degree of blockage.
• MCU (Micturating Cystourethrogram): To rule out reflux (backward flow of urine).
• Blood and urine tests: To check for infection and kidney health.

Treatment and Surgical Correction

Treatment depends on the severity of obstruction, kidney function, and symptoms. Mild cases may be observed with regular follow-up scans. In moderate to severe PUJO, surgical correction is recommended to restore normal urine flow and protect kidney function.

Surgical Procedure – Pyeloplasty

Pyeloplasty is the **gold standard surgery** for correcting PUJO. It involves removing the narrowed or obstructed segment of the ureter and reconnecting the healthy part of the ureter to the kidney pelvis.

• Performed under general anesthesia.
• Can be done using:
  • Open surgery
  • Minimally invasive laparoscopic or robotic techniques
• High success rates (over 95%).
• Requires a short hospital stay and follow-up imaging to ensure proper healing.

Post-Operative Care and Follow-Up

After surgery, regular follow-up is essential to monitor:

• Kidney function and growth
• Resolution of hydronephrosis
• Absence of infections or new obstructions

Most children recover well and lead normal lives after successful pyeloplasty.

Why Choose Dr. Pruthvi Raj Honnaiah?

Dr. Pruthvi Raj Honnaiah is a skilled paediatric urologist with expertise in managing complex congenital kidney conditions like PUJO. Using advanced diagnostic tools and the latest surgical techniques, he ensures your child receives the best care, minimizing hospital stay, discomfort, and long-term risks.