KIDNEY URETER upper tract obstruction

UPPER URINARY TRACT OBSTRUCTION

* Pelviureteric junction obstruction (P.U.J.)

* Stones

* Transitional cell cancer and

* Tuberculosis

9.1 P.U.J. Obstruction (Fig.25.10a)

This is a common cause of hydronephrosis in the young adults  and

children. The narrowing at the pelviureteric junction is  without

demonstrable  cause  (idiopathic)  and it is  possible  that  the

muscle  in  the region of the narrowing does not relax  to  allow

urine to flow freely.

This may be congenital defect, and is, sometimes, bilateral.

9.1.1 CLINICAL FEATURES

The  patient may present with a painless mass in the abdomen  due

to hydroenphrosis.

A moderate sized mass can give rise to dull ache.

9.1.2. INVESTIGATIONS (Fig.25.10b)

The  PUJ  obstruction can be demonstrated by an I.V.P.  There  is

narrowing  at  the  junction of Pelvis  and  ureter  and  delayed

emptying of pelvis.

9.1.3 TREATMENT

The  narrowed segment is removed and the dilated pelvis  repaired

and the healthy ureter joined to the repaired pelvis.

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