PUJ Obstruction with Stone | Pristyn Care

Risk Factors

Risk factors for PUJ obstruction with stone formation include:

• Congenital kidney abnormalities predisposing to urinary stasis
• Family history of PUJ obstruction or hydronephrosis
• Metabolic conditions predisposing to stone formation
• Low fluid intake and concentrated urine in an obstructed system
• History of previous kidney stone surgery
• Recurrent urinary tract infections

Who is at Risk

Patients with known congenital hydronephrosis from PUJ obstruction are at risk of developing stones within the dilated system. Those with recurrent urinary infections or prolonged untreated obstruction are particularly prone to stone formation within the dilated renal pelvis.

Diagnosis

Diagnosis of PUJ obstruction with stone involves:

• Ultrasound showing hydronephrosis and stone
• Non-contrast CT scan to accurately locate the stone and assess PUJ anatomy
• CT urogram or IVP to assess the degree and pattern of obstruction
• Diuretic renogram to assess severity of obstruction and differential kidney function
• Urine culture to detect associated infection
• Blood tests for kidney function assessment

Combined Pyeloplasty and Stone Removal

The gold standard treatment is laparoscopic or robotic dismembered pyeloplasty combined with intraoperative stone removal using flexible ureteroscopy or laparoscopic graspers. Pyeloplasty reconstructs the PUJ to restore normal drainage while stone removal ensures a stone-free outcome in a single procedure. A ureteral stent or nephrostomy is placed postoperatively to support healing.

Combined Pyeloplasty Procedure Steps

Combined pyeloplasty and stone removal is performed as follows:

• General anesthesia and laparoscopic or robotic port placement
• The ureteropelvic junction is identified and mobilized
• The obstructed segment is excised and the pelvis is trimmed to appropriate size
• Stones are removed from the renal pelvis under direct vision or with flexible endoscopy
• The pelvis is anastomosed to the healthy ureter in a dismembered fashion
• A ureteral stent is placed to support the anastomosis during healing
• A drain is placed and ports are removed with skin closure
• Follow-up diuretic renogram at 3 months to confirm obstruction resolution

After Surgery Care

Post-operative care after combined pyeloplasty and stone removal includes:

• Hospital stay of 2 to 3 days with monitoring of drain output
• Ureteral stent removal at 4 to 6 weeks post-surgery
• Adequate hydration and oral pain medications
• Activity restriction for 4 weeks avoiding heavy lifting
• Follow-up ultrasound at 6 weeks to assess hydronephrosis resolution
• Diuretic renogram at 3 months to confirm obstruction resolution

Complications of PUJ Obstruction Surgery

Possible complications of combined pyeloplasty and stone removal include:

• Anastomotic leak causing prolonged drain output
• Failure of pyeloplasty requiring revision surgery
• Residual stone fragments requiring secondary treatment
• Ureteral stricture at the anastomotic site
• Bleeding or injury to adjacent structures
• Urinary tract infection or pyelonephritis post-surgery
• Stent-related discomfort and urinary symptoms during stent period
• Recurrent obstruction from scar tissue formation