PUJO - Pelvi-ureteric Junction Obstruction

A pelvi-ureteric junction obstruction or PUJO is a blockage that can prevent urine from flowing out of the kidneys. Surgery may be needed to clear the obstruction if it is causing symptoms or putting your child's kidney at risk of damage.

What is PUJO?

The pelvi-ureteric junction is the point at which the ureter connects to the renal pelvis of the kidney. The kidney filters waste material out of the bloodstream to produce urine. The urine collects in the renal pelvis and then drains along a tube called the ureter into the bladder, where it will be stored until your child urinates. In about 1 in 1500 children, the pelvic ureteric junction is too narrow. Urine isn't able to flow into the ureter as quickly as usual. The blockage or narrowing is known as a pelvi-ureteric junction obstruction or PUJO.

Signs of Pelvi-ureteric Junction Obstruction

Although PUJO doesn't always cause noticeable symptoms, you might observe some of the following signs in your child:

• often having urinary tract infections
• pain in the back or side
• nausea or vomiting
• blood in the urine
• kidney stones

Causes of PUJO

Many cases of PUJO are simply structural defects that were present at birth. The connection between the ureter and the kidney just happened to be narrower than it should be. When PUJO is due to a birth defect, it can take some time for the symptoms to appear after your baby is born. As urine builds up in the kidneys, you might start to notice some of the signs of PUJO.

PUJO can develop in older children too. The blood vessel that passes across the renal pelvis can sometimes press against the junction, making it harder for urine to move into the ureter. When the problem is caused by a blood vessel, the symptoms can come and go.

Treatments for PUJO

PUJO can increase the chances of developing urinary tract infections. If too much pressure builds up inside the kidneys because of the blocked urine, then there is also a risk of kidney damage. Treatment can help to relieve pain or other symptoms and to prevent issues like these from developing.

Surgery is not always immediately needed to treat a PUJO, but your child's condition will need to be monitored by a paediatric urologist to ensure the problem isn't getting worse and decide the best timing for an intervention. If the blockage is preventing urine from draining from the kidney properly, your child is in pain, or keeps developing urinary infections, then surgery may be needed sooner rather than later to clear the obstruction. The narrow or blocked section of the ureter will be removed so that the renal pelvis can be reattached to the wider part of the ureter. If the issue is caused by a blood vessel, then the ureter can be repositioned before it is reattached to prevent problems.

If you need advice on the treatment options for PUJO it is recommended that you make an appointment to discuss these with a specialist. A paediatric urologist can evaluate your child's condition and help you to make the right decision about surgery.