Pyeloplasty for pelvico-ureteric junction obstruction

A pyeloplasty (kidney pelvis reconstruction) is an operation we do when your child has a blockage between the pelvis (main drainage area) and the ureter (the tube that joins the kidney and the bladder).

For more information, please visit this infoKID resource.

How do I know if my child has pelvico-ureteric junction obstruction (PUJO)?

We find a problem in this area on baby scans, when babies are in their early years or later when the children are more grown up or a teenager.  We find out about it because of swelling on an ultrasound scan without any symptoms or after a urinary tract infection in babies. In the older children, it usually shows up because of side pain.

What is pyeloplasty?

A pyeloplasty is an operation which unblocks part of a tube to let wee reach the bladder.

Do all children with PUJO need a pyeloplasty?

Not all children need a pyeloplasty. Only around 1 in 2 or 1 in 3 children will need one.

For babies we often wait and see for look for key features that mean we need to unblock the kidney. There is a scan called a Mag3 renogram that will show if the area is critically blocked. Please visit this infoKID website for more information on Mag3 renogram.

Other things that might make us need to do an operation include a massive or increasing swelling, or a loss of kidney function. If there is a lot of pressure from a blockage, it can lead to a type of damage in the kidney called ‘nephrons’.

Children with pain that is recurrent or severe, generally need surgery.

If we find that your child’s kidney function is less than 20 percent of normal, we might want to consider other options. These would include a stent or temporarily unblock the kidney and look for recovery or in some cases removing the blocked and damaged kidney might be best. This is called a nephrectomy. Your surgeon will talk you through your options.

How is pyeloplasty done?

A pyeloplasty can be done a 2 ways. This is either though a cut also known as open, or keyhole, using 3 small instruments.

This is generally based on the child’s age. With the small children there is not much benefit to keyhole surgery and they recover well from the ‘open’ operation.  In older children the key hole operation takes longer than the open but they are usually less sore and go home after 1-2 days.

What happens after?

Your child’s surgeon will decide on the stent options:

• no stent
• a blue external stent, which will be removed after a week
• an internal stent which needs a small extra operation to remove it about 6 weeks after the operation

How successful is the operation?

The operation is around 95 percent effective.

The problems that can happen after are infection or the blockage coming back again. This often happens due to problems with healing after the operation.

What is the follow-up like?

Your child will have an early scan after the stent has been removed (if your child had one), and at 12 months we will generally redo the Mag3 renogram. Please visit this infoKID website for more information on Mag3 renogram.

What should I look out for after the operation?

If your child has a temperature or if they are very sore, please ring the team and we will talk you through it.