Postoperative Results Following Surgery for PUJO in Children

Abstract

Pelvi-ureteric junction obstruction (PUJO) is among the most common causes of congeni tal urinary obstruction. With the introduction of antenatal sonography and its universal acceptance a larger number of cases of asymptomatic hydronephrosis are picked up early in the natural history of the disease. However, this hydronephrosis tends to improve or resolve spontaneously in a large number of cases and has forced the treating personnel to alter their understanding of the disease process and redefine the indications for surgical management. In today’s scenario, we are equipped with a lot many options directed towards the management of PUJ obstruction. The spectrum of these options ranges from watchful waiting at the conservative end to balloon dilatation, endopyelotomy and pyeloplasty which could be open, laparoscopic or robotic. Then we have certain exclusively salvage options like ureterocalicostomy or even nephroureterectomy at the extreme end of the spectrum. However, there are a lot many controversies that surround the management of PUJO. The main indication for performing pyeloplasty include; a symptomatic child with pain, sepsis, lump and deteriorating renal functions. A frusemide induced renal scan showing not only the dilatation but also the retention of the isotope even after 4 hours and an obstructive pattern of the drainage curve (in absence