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Mrs Kalpana Patil MB BS MS MCh FRCS(Paed)

Consultant Paediatric Urologist

+44 01932 875168

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Pelviureteric Junction Obstruction

Commonly this is due to a developmental abnormality of the pelviureteric junction. Due to this the entire amount of urine coming from the kidney into this pelvis (space)  cannot find its way through to the ureter. Over time this builds up pressure and causes further dilatation of this space and also back pressure changes on the meat (parenchyma) of the kidney. This may result in the loss of kidney function more so in a rapidly growing kidney of a child.

The investigations that help in coming to a diagnosis  are:

  • Ultrasound of the kidney ureter and bladder (to give information about structure and dimension)
  • Isotope scan to see how the kidney works
  • A MRI scan (magnetic resonance imaging) on rare occasions to clarify the anatomy better

Once the decision to remove this blockage / hold up is made based on the results of the above investigations your child may need an operation called pyeloplasty.

Some useful questions and answers

General

Operation

My results

 

 

General

Q. What is pyeloplasty?
A. An operation to remove the faulty junction (pelviureteric) to allow easy flow of urine from the kidney to the bladder.

Q. Why does your child need this operation?
A. This is a mechanical blockage and does not rectify spontaneously. If this blockage is allowed to remain it can have detrimental effects on the functioning of your child’s kidney due to the backpressure generated.

Operation

Q. What does the operation involve?
A. Your child will need to be given a general anaesthetic for the operation. A paediatric anaesthetist who has experience in anaesthetising children will explain what is involved. You may wish to discuss your queries further with them.

Q. What exactly does this operation involve?
A. See steps below:

1. Hydro

AP Pelvis - Child Urologist

2. Exposure and incision


3. Pathologies incl crossing vessels

 


4. Extent of excision

 


5. Anastomosis and transanastomotic stent

 

 



Q. What happens after the operation
A. You can take your child home after 2 nights if all is well. 48 hours after the operation the stent is knotted prior to discharge home. Then you bring your child back after 7 days to remove the stent on the ward and take him back home the same day after he passes urine a couple of times.

Q. Further follow up?
A. Assessment of success of pyeloplasty is done by a renal tract ultrasound and an isotope scan (Mag3).

You will receive a follow up outpatient appointment after 4 months. At this stage a renal tract ultrasound is done. At further follow up 12 months after the pyeloplasty a renal tract ultrasound and an isotope scan (Mag3 scan) is performed. Your child will be discharged from further follow up if all is well at this follow up.

My results for pyeloplasty operation

 I have had  a 100% success rate for pyeloplasty

 I haven't had to reoperate on any patient  who had a  pyeloplasty operation

  • Stent related problems do occur like leakage around the stent this settles on its own
  • Stent migration is a minor problem and is dealt with  either by  stent removal or leaving it without the planned knotting  to free drainage. This does not have any detrimental effect on the success of the pyeloplasty.

Known complication rates are:

  • Recurrent pelviureteric junction obstruction 2%  requires reoperation
  • Anastomotic leakage 2% minor problem with no serious consequence

 

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