PUJ Obstruction Treatment by Pyeloplasty at Institute of Urology, Jaipur: A 3-month-old male infant was brought to our center by concerned parents following an ultrasound that revealed an obstruction at the pelviureteric junction of the left kidney. The ultrasound findings were significant for hydronephrosis, raising concern for PUJ obstruction.
Following the ultrasound diagnosis, we performed a Diethylenetriamine Pentaacetate (DTPA) scan to further assess the extent of obstruction and the functional capacity of the affected kidney. The scan revealed severely diminished cortical function in the obstructed kidney, along with significant impairment in urine drainage, confirming the need for surgical intervention.
Surgical Plan and Parental Involvement
After a detailed discussion with the parents, we explained the risks of further kidney damage if left untreated, along with the potential benefits of performing Anderson-Hynes Dismembered Pyeloplasty (AHDP). This surgical procedure is the gold standard for correcting PUJ obstruction, particularly in pediatric patients. It involves removing the narrowed section of the ureter and reattaching the healthy portion to ensure smooth urine flow from the kidney to the bladder.
The parents were fully informed about the nature of the surgery, the expected outcomes, and the recovery process. After addressing their concerns and clarifying all aspects of the condition, they consented to the surgery.
Surgical Procedure: Anderson-Hynes Dismembered Pyeloplasty (AHDP)
The surgery was performed successfully under general anesthesia. A careful dissection of the PUJ was carried out, and the narrowed segment was excised. The ureter was then meticulously reconnected to the renal pelvis using Anderson-Hynes dismemberment, ensuring that the obstruction was fully relieved. The procedure was performed without complications, and the surgical site was closed with precision.
Post-surgical monitoring confirmed that the obstruction had been completely resolved, and urine flow from the kidney was re-established. The patient’s recovery was uneventful, and no postoperative complications were observed. The infant was discharged after a brief period of observation, with follow-up scans scheduled to monitor kidney function and drainage.
Discussion
This case underscores the importance of early detection and parental awareness in managing congenital conditions like PUJ obstruction. Without timely intervention, the severe obstruction seen in this infant could have resulted in irreversible renal damage, significantly impacting the child’s health in the long term.
Anderson-Hynes dismembered pyeloplasty (AHDP) remains the gold standard in surgical management of PUJ obstruction, especially in pediatric patients. The technique’s ability to completely relieve obstruction while preserving kidney function is critical in cases where the affected kidney is already compromised. In this case, the early diagnosis, combined with prompt surgical correction, has likely saved the infant’s kidney from further deterioration, giving him the best chance for normal renal function as he grows.
Parental vigilance played a key role in this case. Recognizing potential symptoms or abnormalities during routine health checks led to an early diagnosis and prompt treatment. This highlights the importance of educating parents about the need for timely medical intervention in congenital urological conditions.
At the Institute of Urology, we are committed to providing world-class diagnostic and surgical care, adhering to international protocols to ensure the best outcomes for our patients.
Our expertise in handling complex pediatric urological cases, along with the use of advanced surgical techniques, allows us to deliver the highest standard of care, ensuring that children like this patient have the best possible future kidney function.
