Pelviureteric junction (PUJ) obstruction is a congenital or acquired condition that leads to impaired urine flow from the renal pelvis to the ureter, potentially resulting in progressive renal damage. Early diagnosis and timely intervention are crucial in preventing long-term complications. This case report presents a 2.2-year-old child diagnosed with PUJ obstruction and successfully treated at the Institute of Urology, Jaipur.
Case Presentation
A 2.2-year-old baby was brought to a medical facility with complaints of left flank pain. Concerned about their child’s discomfort, the parents sought medical advice and underwent initial investigations. An ultrasound revealed left-sided hydronephrosis, leading them to consult us at the Institute of Urology, Jaipur for expert guidance and further evaluation.
Diagnostic Workup Upon presentation, a thorough diagnostic approach was undertaken to confirm the suspicion of PUJ obstruction:
- Ultrasound (USG):
- Findings included hydroureter, hydropelvis, and mild cortical parenchymal thinning.
- The results strongly suggested a high probability of PUJ obstruction.
- Multidetector Computed Tomography (MDCT) Urography:
- Revealed grade III hydronephrosis with significant ballooning of the renal pelvis.
- Provided confirmatory evidence of left PUJ obstruction.
- Diethylenetriamine Pentaacetic Acid (DTPA) Renal Scan:
- Indicated moderate cortical dysfunction of the left kidney, confirming impaired renal function.
- The right kidney was found to be completely normal.
Given the conclusive findings, a detailed discussion was held with the parents regarding the necessity of surgical intervention to prevent further renal deterioration.
Surgical Management After obtaining informed consent, the child underwent:
- Retrograde Pyelography (RGP) to further delineate the anatomy of the PUJ obstruction.
- Dismembered Anderson-Hynes Pyeloplasty with DJ Stent Placement, performed under the expert supervision of Dr. M. Roychowdhury and Dr. Rajan Bansal at our institute.
The procedure was completed successfully, with intraoperative findings consistent with the preoperative diagnosis. The patient tolerated the surgery well, and post-procedure monitoring was initiated.
Postoperative Outcome and Follow-up Following surgery:
- The child showed significant clinical improvement with resolution of flank pain.
- A repeat ultrasound post-surgery demonstrated reduced hydronephrosis, indicating the success of the procedure.
- The parents were counseled regarding post-operative care, stent removal, and the importance of regular follow-ups to monitor renal function and recovery.
Discussion This case underscores the importance of recognizing early signs of PUJ obstruction in children. Flank pain, though seemingly benign, can be an indicator of underlying renal pathology. Timely imaging and renal function assessment play a pivotal role in ensuring optimal patient outcomes. Surgical intervention in pediatric PUJ obstruction has shown excellent success rates, particularly when performed in experienced centers.
Conclusion At the Institute of Urology, Jaipur, we specialize in diagnosing and managing complex pediatric urological conditions. Our state-of-the-art infrastructure, combined with personalized patient care, ensures best-in-class outcomes for every child we treat. We take a patient-centric approach, ensuring that every family is well-informed and supported throughout their child’s treatment journey. Since our inception, we have been at the forefront of pediatric urology, offering advanced surgical expertise and cutting-edge medical care.
This case reinforces the importance of early diagnosis, expert surgical intervention, and long-term follow-up in ensuring the well-being of pediatric patients with PUJ obstruction. The success of this case is a testament to our commitment to excellence in urology and our dedication to providing the best possible care for our young patients.
