Pyeloplasty for Pelviureteric Junction Obstruction (PUJO)
DEFINITION
PUJO is a congenital condition that children may be born with, where there is a blockage or a limitation of the flow of urine, and the junction between the renal pelvis, and the ureter (see diagram).
This blockage may be complete, partial, or intermittent. PUJO may be intrinsic (within the wall of the renal pelvis), or extrinsic, such as from an abnormal blood vessel pressing on the outside of the ureter and causing a kink.
Pyeloplasty is an operation where the PUJ is removed and reconstructed to relieve the blockage.
Pyeloplasty may be performed as open surgery, laparoscopic (minimal access), or robot assisted.
GOALS OF CARE
The operation is intended to relieve the obstruction, and reconstruct the join between the renal pelvis and the ureter, which is wide enough to allow fast drainage of urine, water tight, and in a ‘dependent position’ to encourage urine drainage with gravity.
The long term goals are to reduce the risk of infection, prevent pain if it is occurring, and prevent the kidney function from deteriorating over time.
If the blockage is so severe that the kidney is functioning very poorly, or is no longer working at all, a pyeloplasty does not need to be performed. If a non-functioning kidney causes pain, high blood pressure or infections, then the entire kidney should be removed.
OUTCOMES
Pyeloplasty is a common operation. For the relief of obstruction, it is successful in 90-95% of cases.
The risk of persistent or blockage that requires a repeat operation is 10%. This may be obvious soon after the operation, or may not become apparent for months or years afterwards.
The risk of leaking of urine from the newly joined renal pelvis and ureter is between 1 and 5%, and will most often settle spontaneously by leaving a catheter in the bladder, a stent in the kidney, and a drain next to the kidney in until the leak dries up. Immediate reoperation is very rarely required.
OUR APPROACH
Dr Rob performs pyeloplasty in children who have evidence of profound blockage, with or without pain, or partial blockage with a drop in kidney function. Dr Rob utilises a laparoscopic (key hole) approach in all ages. The operation usually takes 2.5 - 4 hours. There will be three small incisions on their abdomen, which will be closed with dissolving sutures, glue and a small dressing.
POST OPERATIVE RECOVERY AND CARE
When your child wakes up from their operation, they will have a catheter in their bladder. They will be permitted to drink liquids right away, and can have solid food once they show signs of their intestines are functioning well. They will receive antibiotic therapy until the catheter is removed. The catheter will be removed on the second or third day of their admission and if they have a drain, it will be removed a few hours after the catheter.
Your child will see Dr Rob 1 week after the surgery in the clinic to ensure they are making the expected recovery.
6 weeks after the pyeloplasty, your child will have another short anaesthetic to have the kidney stent removed via the bladder using a camera called a cystoscope. There will be no incisions. This is a day procedure, so you will take your child home again later that same day.
Dr Rob will then see you and your child in 6-12 weeks with another scan of the kidneys. You will be seen every 3-12 months for a few years to monitor the growth of your childs kidney and check for signs of recurrent blockage.