PELVI-URETERIC JUNCTION OBSTRUCTION - A TEN YEAR SINGLE CENTER REVIEW IN NORTH CENTRAL NIGERIA
Abstract
Background: PUJ obstruction (PUJO) is a functional or anatomic obstruction to urine flow from the renal pelvis to the proximal ureter. Late presentation is common in our environment. It is a common cause of neonatal and prenatal hydronephrosis, occurring in one per 1500 live births. It is less common in adults than in children but it is not rare in either population. Congenital causes of PUJO is more in males than females, 2-4:1 with left sided obstruction being commoner than the right. Most common etiology of PUJO is congenital obstruction (narrowing, crossing vessels). Acquired causes include calculi and stricture.
Objectives: We reviewed the outcome of our management of congenital and acquired PUJ obstruction over a 10-year period at University of Abuja Teaching Hospital Nigeria.
Methodology: This study was retrospective in nature, from January 2006 to December 2015. All patients who presented with clinical and radiological features of PUJO at any age of life were included in the study. Information obtained included age, sex, presenting symptoms, duration of symptoms, side of obstruction, the nature of the intervention performed, as well as whether a ureteric stent was used or not and if yes what type. The results of relevant clinical, laboratory and radiological investigations were noted. The data obtained was tabulated and analysed in the form of mean, median, mode, and percentages using Microsoft Excel and SPSS version16.
Results: Forty-one patients with PUJO were seen, 18 with congenital PUJO, 21 with renal calculi and 2 with strictures. The age range was 3 to 67 years, and mean age of 33.1 +/-15.7 years. The range of symptom duration was between 1 month to 180 months (15years), mean duration of 17.6 +/- 30.3 months. Anderson hynes pyeloplasty was done in 16 patients (14 patients with congenital PUJO and 2 with strictures). One patient with congenital PUJO had foley YV pyeloplasty. Three patients with congenital PUJO had simple nephrectomies for nonfunctional kidneys with severe flank pains. The 21 patients with calculi all had open pyelolithotomy. Twenty-two patients had ureteric stents inserted either using double J or improvising with small size feeding tubes intraoperatively. All patients had remarkable improvements in symptoms during followup.
Conclusion: PUJ obstruction is a common abnormality of the upper urinary tract. Presentation in later life is common in our environment even for congenital pathology. Renal pelvic stones were the most common aetiological cause of PUJ obstruction in our centre (51%), followed closely by congenital causes (39%).
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References
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