SlideShare a Scribd company logo

Pelvi-ureteric junction obstruction

for more information and get download version visit drarjunpawar.com Pelvi-ureteric junction obstruction

1 of 43
Pelvi-Ureteric Junction
Obstruction
Dr. Arjun A. Pawar
MBBS, MS,
M. Ch. Pediatric Surgery,
DNB Pediatric Surgery,
FMAS,
FIAGES.
Divine Pediatric Surgery Centre. i.
a. w.
Hydronephrosis- Aseptic dilatation of
pelvicalyceal system
SFU
UTD – Urinary tract dilatation
Pelvi-ureteric junction obstruction
Causes of Antenatal Hydronephrosis
Pelvi-ureteric junction obstruction
Ad

Recommended

Management of pelviureteric junction obstruction onyeze copy
Management of pelviureteric junction obstruction onyeze   copyManagement of pelviureteric junction obstruction onyeze   copy
Management of pelviureteric junction obstruction onyeze copyChigozie Onyeze
 
Congenital genito urinary disorders
Congenital  genito  urinary disordersCongenital  genito  urinary disorders
Congenital genito urinary disordersHelan Henna
 
POSTERIOR URETERAL VALVES (PUV )
POSTERIOR URETERAL VALVES (PUV )POSTERIOR URETERAL VALVES (PUV )
POSTERIOR URETERAL VALVES (PUV )leelakrishnakarri
 
Ureteropelvic junction obstruction in children
Ureteropelvic junction obstruction in childrenUreteropelvic junction obstruction in children
Ureteropelvic junction obstruction in childrenMUSTAFA MAJID
 
Congenital ureteropelvic (upj) obstruction
Congenital ureteropelvic (upj) obstructionCongenital ureteropelvic (upj) obstruction
Congenital ureteropelvic (upj) obstructionMo7ammed Nabil Al Ali
 
Posterior urethral valve
Posterior urethral valvePosterior urethral valve
Posterior urethral valveMakafui Yigah
 

More Related Content

Similar to Pelvi-ureteric junction obstruction

Urological emergencies
Urological emergenciesUrological emergencies
Urological emergenciesAhmed Eliwa
 
hydronephrosis.pptx
hydronephrosis.pptxhydronephrosis.pptx
hydronephrosis.pptxRay Victor
 
Etiopathogenesis, Evaluation & Management of Posterior Urethral Valve
Etiopathogenesis, Evaluation & Management of Posterior Urethral ValveEtiopathogenesis, Evaluation & Management of Posterior Urethral Valve
Etiopathogenesis, Evaluation & Management of Posterior Urethral ValveShubham Lavania
 
Pelvi ureteric junction obstruction in children
Pelvi ureteric junction obstruction in childrenPelvi ureteric junction obstruction in children
Pelvi ureteric junction obstruction in childrenAseesh Varma
 
Pathophysioogy of urinary tract obstruction bassem presentation
Pathophysioogy of urinary tract obstruction bassem presentationPathophysioogy of urinary tract obstruction bassem presentation
Pathophysioogy of urinary tract obstruction bassem presentationfreeburn simunchembu
 
Obstructive Uropathy "online"
Obstructive Uropathy "online"Obstructive Uropathy "online"
Obstructive Uropathy "online"Ayman Rashed, MD
 
Urinary disorders watson (2)
Urinary disorders  watson (2)Urinary disorders  watson (2)
Urinary disorders watson (2)shenell delfin
 
Renal Development Dysplasia 2
Renal Development Dysplasia 2Renal Development Dysplasia 2
Renal Development Dysplasia 2guesteb049
 
Ultrasound of the urinary tract - Renal infections
Ultrasound of the urinary tract - Renal infectionsUltrasound of the urinary tract - Renal infections
Ultrasound of the urinary tract - Renal infectionsSamir Haffar
 
Gu anomaly for nursing school
Gu anomaly for nursing schoolGu anomaly for nursing school
Gu anomaly for nursing schoolMukhtar Mahdy
 
Sarita,gm20-116,topic -4.pptx
Sarita,gm20-116,topic -4.pptxSarita,gm20-116,topic -4.pptx
Sarita,gm20-116,topic -4.pptxssuser3d2170
 
Urinary system disorders.pptx1
Urinary system disorders.pptx1Urinary system disorders.pptx1
Urinary system disorders.pptx1Eric Pazziuagan
 
Acute Renal Failure
Acute Renal FailureAcute Renal Failure
Acute Renal FailureJames Brown
 
Hydronephrosis.pptx
Hydronephrosis.pptxHydronephrosis.pptx
Hydronephrosis.pptxSreevani49
 
Postnatal mangement of anh (2)
Postnatal mangement of anh (2)Postnatal mangement of anh (2)
Postnatal mangement of anh (2)Mohamed Mustafa
 

Similar to Pelvi-ureteric junction obstruction (20)

PUJ obstruction.pptx
PUJ obstruction.pptxPUJ obstruction.pptx
PUJ obstruction.pptx
 
Urological emergencies
Urological emergenciesUrological emergencies
Urological emergencies
 
hydronephrosis.pptx
hydronephrosis.pptxhydronephrosis.pptx
hydronephrosis.pptx
 
PUJO.pptx
PUJO.pptxPUJO.pptx
PUJO.pptx
 
Etiopathogenesis, Evaluation & Management of Posterior Urethral Valve
Etiopathogenesis, Evaluation & Management of Posterior Urethral ValveEtiopathogenesis, Evaluation & Management of Posterior Urethral Valve
Etiopathogenesis, Evaluation & Management of Posterior Urethral Valve
 
Urology 5th year, 1st lecture (Dr. Sarwar)
Urology 5th year, 1st lecture (Dr. Sarwar)Urology 5th year, 1st lecture (Dr. Sarwar)
Urology 5th year, 1st lecture (Dr. Sarwar)
 
UPJ Obstruction
UPJ ObstructionUPJ Obstruction
UPJ Obstruction
 
Pelvi ureteric junction obstruction in children
Pelvi ureteric junction obstruction in childrenPelvi ureteric junction obstruction in children
Pelvi ureteric junction obstruction in children
 
Pathophysioogy of urinary tract obstruction bassem presentation
Pathophysioogy of urinary tract obstruction bassem presentationPathophysioogy of urinary tract obstruction bassem presentation
Pathophysioogy of urinary tract obstruction bassem presentation
 
Obstructive Uropathy "online"
Obstructive Uropathy "online"Obstructive Uropathy "online"
Obstructive Uropathy "online"
 
Urinary disorders watson (2)
Urinary disorders  watson (2)Urinary disorders  watson (2)
Urinary disorders watson (2)
 
Renal Development Dysplasia 2
Renal Development Dysplasia 2Renal Development Dysplasia 2
Renal Development Dysplasia 2
 
Ultrasound of the urinary tract - Renal infections
Ultrasound of the urinary tract - Renal infectionsUltrasound of the urinary tract - Renal infections
Ultrasound of the urinary tract - Renal infections
 
Gu anomaly for nursing school
Gu anomaly for nursing schoolGu anomaly for nursing school
Gu anomaly for nursing school
 
Sarita,gm20-116,topic -4.pptx
Sarita,gm20-116,topic -4.pptxSarita,gm20-116,topic -4.pptx
Sarita,gm20-116,topic -4.pptx
 
Urinary system disorders.pptx1
Urinary system disorders.pptx1Urinary system disorders.pptx1
Urinary system disorders.pptx1
 
Acute Renal Failure
Acute Renal FailureAcute Renal Failure
Acute Renal Failure
 
Puj obstruction
Puj obstructionPuj obstruction
Puj obstruction
 
Hydronephrosis.pptx
Hydronephrosis.pptxHydronephrosis.pptx
Hydronephrosis.pptx
 
Postnatal mangement of anh (2)
Postnatal mangement of anh (2)Postnatal mangement of anh (2)
Postnatal mangement of anh (2)
 

More from DrArjunPawar

Pediatric Constipation
Pediatric ConstipationPediatric Constipation
Pediatric ConstipationDrArjunPawar
 
Infantile hypertrophic pyloric stenosis
Infantile hypertrophic pyloric stenosisInfantile hypertrophic pyloric stenosis
Infantile hypertrophic pyloric stenosisDrArjunPawar
 
Common Surgical conditions in kids
Common Surgical  conditions in kidsCommon Surgical  conditions in kids
Common Surgical conditions in kidsDrArjunPawar
 
Phimosis, inguinal hernia & undescended testis.pptx
Phimosis, inguinal hernia & undescended testis.pptxPhimosis, inguinal hernia & undescended testis.pptx
Phimosis, inguinal hernia & undescended testis.pptxDrArjunPawar
 
Pediatric Intussusception
Pediatric IntussusceptionPediatric Intussusception
Pediatric IntussusceptionDrArjunPawar
 
Choledochal cyst & Biliary atresia.pptx
Choledochal cyst & Biliary atresia.pptxCholedochal cyst & Biliary atresia.pptx
Choledochal cyst & Biliary atresia.pptxDrArjunPawar
 
Anorectal malformation.pptx
Anorectal malformation.pptxAnorectal malformation.pptx
Anorectal malformation.pptxDrArjunPawar
 

More from DrArjunPawar (7)

Pediatric Constipation
Pediatric ConstipationPediatric Constipation
Pediatric Constipation
 
Infantile hypertrophic pyloric stenosis
Infantile hypertrophic pyloric stenosisInfantile hypertrophic pyloric stenosis
Infantile hypertrophic pyloric stenosis
 
Common Surgical conditions in kids
Common Surgical  conditions in kidsCommon Surgical  conditions in kids
Common Surgical conditions in kids
 
Phimosis, inguinal hernia & undescended testis.pptx
Phimosis, inguinal hernia & undescended testis.pptxPhimosis, inguinal hernia & undescended testis.pptx
Phimosis, inguinal hernia & undescended testis.pptx
 
Pediatric Intussusception
Pediatric IntussusceptionPediatric Intussusception
Pediatric Intussusception
 
Choledochal cyst & Biliary atresia.pptx
Choledochal cyst & Biliary atresia.pptxCholedochal cyst & Biliary atresia.pptx
Choledochal cyst & Biliary atresia.pptx
 
Anorectal malformation.pptx
Anorectal malformation.pptxAnorectal malformation.pptx
Anorectal malformation.pptx
 

Recently uploaded

Renal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and PhosphorusRenal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and PhosphorusMedicoseAcademics
 
SEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdf
SEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdfSEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdf
SEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdfmarlonduqueupb
 
Approach to maternal collapse and cardiac arrest.pptx
Approach to maternal collapse and cardiac arrest.pptxApproach to maternal collapse and cardiac arrest.pptx
Approach to maternal collapse and cardiac arrest.pptxKTD Priyadarshani
 
Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)MedicoseAcademics
 
pediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.pptpediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.pptArun170190
 
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptxGLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptxWINCY THIRUMURUGAN
 
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptxBiochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptxRajendra Dev Bhatt
 
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...Abhinav S
 
Seminario biologia molecular-Universidad Pontificia Bolivariana.
Seminario biologia molecular-Universidad Pontificia Bolivariana.Seminario biologia molecular-Universidad Pontificia Bolivariana.
Seminario biologia molecular-Universidad Pontificia Bolivariana.JULIANA BENAVIDES GUERRERO
 
Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...
Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...
Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...Subrata Roy
 
Tolerance Hydra10P Avene trainings blink
Tolerance Hydra10P Avene trainings blinkTolerance Hydra10P Avene trainings blink
Tolerance Hydra10P Avene trainings blinkClinicians
 
Cell cytoskeleton and molecular motors.pdf
Cell cytoskeleton and molecular motors.pdfCell cytoskeleton and molecular motors.pdf
Cell cytoskeleton and molecular motors.pdfMedicoseAcademics
 
odontogenic keratocyst a developmental cyst
odontogenic keratocyst  a developmental cystodontogenic keratocyst  a developmental cyst
odontogenic keratocyst a developmental cystJani253068
 
USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.
USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.
USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.vrchk912
 
HEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studies
HEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studiesHEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studies
HEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studiesRichard Clement
 
Anesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptxAnesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptxhrowshan
 
Autism and Savant Syndrome|Study|The Good doctor .pptx
Autism and Savant Syndrome|Study|The Good doctor .pptxAutism and Savant Syndrome|Study|The Good doctor .pptx
Autism and Savant Syndrome|Study|The Good doctor .pptxScripted Symptoms
 
ABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdf
ABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdfABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdf
ABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdfAbdurahmanRafeeq
 
https://getneurozoom.cc/welcome#aff=musvi5
https://getneurozoom.cc/welcome#aff=musvi5https://getneurozoom.cc/welcome#aff=musvi5
https://getneurozoom.cc/welcome#aff=musvi5Hussain Syed
 
113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdf
113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdf113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdf
113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdfKs doctor
 

Recently uploaded (20)

Renal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and PhosphorusRenal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and Phosphorus
 
SEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdf
SEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdfSEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdf
SEMINARIO VIH BIOLOGIA MOLECULAR PDF.pdf
 
Approach to maternal collapse and cardiac arrest.pptx
Approach to maternal collapse and cardiac arrest.pptxApproach to maternal collapse and cardiac arrest.pptx
Approach to maternal collapse and cardiac arrest.pptx
 
Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)
 
pediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.pptpediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.ppt
 
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptxGLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
 
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptxBiochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
Biochemistry of Carbohydrates for MBBS, BDS, Lab Med 2024.pptx
 
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
Circulatory shock Cardiogenic Shock Hypovolemic Shock Sepsis, Septic Shock an...
 
Seminario biologia molecular-Universidad Pontificia Bolivariana.
Seminario biologia molecular-Universidad Pontificia Bolivariana.Seminario biologia molecular-Universidad Pontificia Bolivariana.
Seminario biologia molecular-Universidad Pontificia Bolivariana.
 
Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...
Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...
Work-role of Radiation Therapists in the Consequences of Adaptive Radiotherap...
 
Tolerance Hydra10P Avene trainings blink
Tolerance Hydra10P Avene trainings blinkTolerance Hydra10P Avene trainings blink
Tolerance Hydra10P Avene trainings blink
 
Cell cytoskeleton and molecular motors.pdf
Cell cytoskeleton and molecular motors.pdfCell cytoskeleton and molecular motors.pdf
Cell cytoskeleton and molecular motors.pdf
 
odontogenic keratocyst a developmental cyst
odontogenic keratocyst  a developmental cystodontogenic keratocyst  a developmental cyst
odontogenic keratocyst a developmental cyst
 
USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.
USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.
USG,CT AND MR IMAGING OF HEPATIC MASS LESIONS.
 
HEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studies
HEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studiesHEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studies
HEPATIKA 6 Nutritional supplement, six ingredients supported by clinical studies
 
Anesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptxAnesthesia Implications in cannabis Users.pptx
Anesthesia Implications in cannabis Users.pptx
 
Autism and Savant Syndrome|Study|The Good doctor .pptx
Autism and Savant Syndrome|Study|The Good doctor .pptxAutism and Savant Syndrome|Study|The Good doctor .pptx
Autism and Savant Syndrome|Study|The Good doctor .pptx
 
ABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdf
ABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdfABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdf
ABDULRAHMAN AL RAFIQ UPDATED MANAGEMENT OF ACUTE PULMONARY EMBOLISM .pdf
 
https://getneurozoom.cc/welcome#aff=musvi5
https://getneurozoom.cc/welcome#aff=musvi5https://getneurozoom.cc/welcome#aff=musvi5
https://getneurozoom.cc/welcome#aff=musvi5
 
113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdf
113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdf113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdf
113/02/16-達文西機械手臂手術於耳鼻喉之應用-講師:蘇彥燁主治醫師.pdf
 

Pelvi-ureteric junction obstruction

  • 1. Pelvi-Ureteric Junction Obstruction Dr. Arjun A. Pawar MBBS, MS, M. Ch. Pediatric Surgery, DNB Pediatric Surgery, FMAS, FIAGES. Divine Pediatric Surgery Centre. i. a. w.
  • 2. Hydronephrosis- Aseptic dilatation of pelvicalyceal system SFU
  • 3. UTD – Urinary tract dilatation
  • 5. Causes of Antenatal Hydronephrosis
  • 9. Introduction Incidence - 1 in 1250 live births M:F=2:1 PUJO- Adynamic segment High grade vs Low grade Intrinsic Vs Extrinsic
  • 11. Etiology Primary PUJO: Intrinsic obstruction – Scarring of ureteric valves Ureteral hypoplasia- Inhibit the natural peristaltic emptying Abnormal or high insertion of the ureter Crossing lower-pole renal vessel(s) Renal ectopy Renal Hypermobility Secondary PUJO: Renal stone disease, Failed repair,
  • 12. Pathophysiology Adynamic segment in upper ureter, Obstructing lesions(Valves, Polyps) Folds(Persistent Ostlings folds). Complete obstruction- Rapid deterioration of function Partial obstruction- Gradual deterioration of function
  • 13. Clinical Presentation Increasing prenatal detection- 80% Asymtomatic PUJO in infants Abdominal lump Abdominal pain Urinary tract infection Dietl’s crisis Hematuria, Hypertension Association with other anomalies- Anorectal, syndromes-MRKH
  • 14. Evaluation •Blood Ix: CBC, KFT, Urine, HIV, HbsAg, •USG •MCU •IVP •EC Scan/ MAG3 scan +- DMSA scan •CT KUB scan •MR Urography
  • 15. Investigations: Ultrasonography •Ideal screening tool • Anteroposterior pelvic diameter (APPD) • Cranio caudal diameter of pelvis • Parenchymal thickness (UPPT, MPPT, LPPT) • Bipolar renal length • Kindney size • Ureter • Bladder • Posterior urethra details • RI- Kidney •Limitations •Operator dependant •body habitus •overlying bowel gas •patient cooperation
  • 16. USG •The first postnatal USG 48 to 72 hrs after birth •RI > 0.75 - obstruction requiring surgery •Sensitivity ~ 90 – 95%, •Specificity ~ 85%
  • 17. Diuretic Renogram •Functional investigation: 99mTc-Diethylenetriaminepentaacetic acid (DTPA) 99mTc-Mercaptoacetyltriglycine (MAG3) 99mTc -Ethylene dicysteine (EC) Radiopharmeceuti cal Renal Handling Application DTPA GFR dependent clearance Renography MAG3 Mainly by tubular secretion Renography EC Tubular secretion Renography
  • 18. Diuretic Renogram Replaced IVP – negligible radiation Sensitivity 100% and Specificity 94% Objective assessment:  Renal blood flow Differential renal function Intra renal transit time Time taken for radioisotope washout from the pelvicalyceal system (t½) Follow-up and postoperative assessment
  • 20. Diuretic Renogram The “Well – Tempered” renogram – standard practice and comparable results  Hydration  Bladder catheter  Furosemide injection – F0/F15 protocol First Renogram  EC - 4 Wks of Age  MAG3- 15 days
  • 21. Magnetic Resonance Urography •MR renography (Gd – DTPA) Anatomic and functional assessment •Selective usage- anatomical anomalies- Duplex, ectopia, malrotation
  • 22. Indications for Pyeloplasty Differential renal function below 40% Decrease in DRF > 5% on subsequent renal scintigraphy scan T ½ max - >20 min Recurrent urinary tract infections Rapid aggravation of hydronephrosis Severe bilateral hydronephrosis due to PUJO
  • 23. Indications for Pyeloplasty •DOCUMENTED OBSTRUCTION on nuclear imaging irrespective of DRF and grade of hydronephrosis •Equivocal - regular and close follow up
  • 24. Types of Pyeloplasty Three types: The intubated type The flap types The dismembered type
  • 25. Intubated pyeloplasty •Long segments of narrowing of ureter •Contraindicated in aberrant lower polar artery •Higher fibrosis and restenosis rates •Long term success rates - 50 – 88 %
  • 26. Flap Repairs •Pelvic flaps without sacrificing ureteropelvic continuity- for Small extra renal pelvis Foley Y – V plasty Culp – DeWeerd spiral flap Scardinho – Prince vertical flap • Rarely performed and have specific indications
  • 27. Dismembered pyeloplasty Modified Anderson Hynes Pyeloplasty for PUJ obstruction Excision of redundant pelvis Excision of pathological PUJ segment Spatulated wide ureteropelvic anastomosis Dependent Water tight Tension free anastomosis
  • 29. Approaches Open Surgery: Flank Approach Dorsal Lumbotomy Approach Anterior Subcostal Approach Laparoscopic Surgery: Transperitoneal approach Retroperitoneal approach Robotic assisted Surgery:
  • 34. Complications and Outcome Bleeding and infection Prolonged urinary extravasation Perirenal Urinoma Urosepsis D-J stent migration Delayed opening of the anastomosis Anastomotic stricture
  • 36. PUJ and polar vessels •Often a surprise •Rarely associated with intrinsic PUJ obstruction •Pyelopyelostomy •A-H Pyeloplasty
  • 37. PUJ and VUJ obstruction •The saline flush test for distal patency •Missed VUJ obstruction – large low pelvis •DJ stent / nephrostomy till VUJ is addressed (Ureteric reimplantation )
  • 38. PUJ obstruction and VUR •10% PUJO – concurrent reflux •Routine MCU Bilateral HDN Ureteric dilatation on preop USG • Dilated ureter at operation • Pyeloplasty - post op MCU / DMSA • Manage VUR on merits
  • 40. Poorly functioning kidney • ? nephrectomy for split function < 10% •Has potential for recovery – younger child •Preoperative DMSA/PCN •Split renal Cr clearance
  • 41. Duplex kidney •Obstruction may be seen in either unit •Diagnosis usually on radionuclide scan •MCU /IVP/MRU •AH pyeloplasty •Pyeloureterostomy
  • 42. Horseshoe Kidney •Largely asymptomatic •Significant obstruction – dismembered pyeloplasty •Laparoscopic / Robotic – good results