PUJ obstruction (blockage where the kidney meets the ureter)PUJ obstruction (kidney aur ureter ke jorr par rukawat)

PUJ obstruction kya hai

Har kidney peshab ko darmiyan ke aik hisse mein jama karti hai jise renal pelvis kehte hain. Wahan se peshab aik patli nali, ureter, mein behta hai jo isay bladder tak le jati hai. Jahan pelvis ureter se milta hai use pelvi-ureteric junction (PUJ) kehte hain. PUJ obstruction mein yeh jorr tang ya band hota hai, is liye peshab aahista nikalta hai aur kidney sooj jati hai (isay hydronephrosis kehte hain).

Kuch PUJ obstruction halke hote hain aur nuqsan nahi karte. Doosre agar ilaaj na ho to kidney ko aahista nuqsan pohanchate hain. Dekh bhaal ka maqsad yeh maloom karna hai ke aap ya aap ke bachay ko kaun si qism hai. Yeh guide batati hai ke yeh kaise pakra jata hai, tests, kab sirf nigrani kaafi hai aur kab operation ka mashwara diya jata hai. Yeh bado aur walidain ke liye hai.

Scan par kidney ka soojha hona hamesha operation ki zaroorat nahi batata. Maahir bata sakta hai ke kidney kaafi acha bah rahi hai aur aam tarah kaam kar rahi hai ya nahi.

Yeh kaise pakri jati hai

PUJ obstruction bachon mein kidney ke sooj jane ki aam wajohat mein se aik hai, aur aksar hamal ke dauran scan mein pakri jati hai. Bade bachon aur baalighon mein yeh tab pakri jati hai jab peshab ka infection, pehlu ya kamar mein dard, kidney ki pathri, peshab mein khoon ho, ya kisi aur wajah se scan ho. Kabhi kabhi yeh bagair kisi alamat ke ittefaq se mil jati hai. Yeh aik kidney ya, kam aam tor par, dono ko mutasir kar sakti hai.

Yeh kyun hota hai

Aksar jorr paidaish se tang hota hai, ya to is liye ke deewar ka muscle theek kaam nahi karta ya ureter kidney se ghalat jagah milta hai. Kuch logon mein ureter ke samne se guzarti hui khoon ki nali us par dabao dalti hai. Baalighon mein yeh kidney ki pathri, infection, chot ya operation ke baad nishan ban jane se bhi ho sakta hai.

Yeh kisi aisi cheez se nahi hota jo maan ne hamal ke dauran ki ya na ki, aur yeh khuraak ya wazan uthane se nahi hota. Meherbani karke apne aap ko qasoorwar na thehrayen.

Aam nishaniyan

Bohat se log, aur bohat se bachay, koi alamat nahi rakhte. Jab hoti hain to yeh ho sakti hain:

• Pehlu ya kamar mein dard, jo aata jata ho aur bohat pani peene ke baad zyada ho sakta hai.
• Peshab ke infection, kabhi bukhar, ulti ya bimari ke ehsaas ke saath. Chhote bachon mein sirf bukhar hi nishani ho sakta hai.
• Peshab mein khoon, kabhi halki chot ke baad.
• Sooji hui kidney mein pathri ka banna.
• Pehlu ya pait mein gaanth, jo zyada tar chhote bachon mein nazar aati hai.
• Chhote bachon mein: doodh kam peena, kam barhna ya ulti.

Jaanch kaise hoti hai

Aap ke doctor aam tor par yeh karwayenge:

• Ultrasound, jis se pata chalta hai ke kidney kitni soojhi hui hai aur doosri kidney theek hai ya nahi. Yeh mehfooz aur dard se paak hai, aur dohraya ja sakta hai.
• Peshab ka test, infection dekhne ke liye.
• Kidney ke kaam ka (renogram) scan, jis mein ragh mein bezarar nishan-dahi ka maada lagaya jata hai. Is se pata chalta hai ke har kidney kitna kaam kar rahi hai aur peshab theek nikalta hai ya nahi. Yeh operation ka faisla karne ka aham test hai.
• Khoon ke tests, kidneys dekhne ke liye.
• Kabhi kabhi CT ya MRI scan, zyada tar bade bachon aur baalighon mein, operation se pehle khoon ki nalion aur banawat dekhne ke liye.
• Kabhi kabhi chhote bachon mein bladder aur ureters ka scan, reflux dekhne ke liye (dekhein vesicoureteric reflux guide).

Kab sirf nigrani kaafi hai

Har PUJ obstruction ko operation ki zaroorat nahi hoti. Bohat se bachon mein, aur kuch bade bachon aur baalighon mein, kidney acha kaam kar rahi hoti hai aur sojan halki hoti hai. In soorton mein maahir baqaida scans aur peshab ke tests ke saath nigrani ka mashwara de sakta hai, kyunke bohat se bachay waqt ke saath behtar ho jate hain. Isay watchful waiting kehte hain. Yeh tay shuda tareeqa hai, kuch na karna nahi.

Watchful waiting tab hi kaam karta hai jab follow-up scans kiye jayein. Agar kidney ka kaam kam ho, sojan barhe, infection shuru hon ya dard ho to plan operation mein badal sakta hai. Meherbani karke yeh appointments na chhorein.

Ilaaj ke tareeqay

Operation ka mashwara tab diya jata hai jab kidney kaafi acha kaam ya nikasi nahi kar rahi, bigar rahi ho, ya dard, infection ya pathri ka sabab ban rahi ho. Bunyadi intikhabat:

Pyeloplasty zyada tar logon mein acha kaam karta hai. Aap ke surgeon khatre samjhayenge, jin mein infection, khoon behna, stent ki wajah se takleef aur kabhi tangi ka wapis aana shamil hai. Meherbani karke haan kehne se pehle koi bhi sawal poochein.

Operation ke baad

Zyada tar log thore arse ke liye hospital mein rehte hain. Chand din catheter aur drain istemal ho sakte hain. Agar stent rakhi gayi ho to baad mein nikal di jayegi. Jab tak andar ho, thori jaldi, takleef ya peshab mein khoon ho sakta hai. Baad mein scans dohraye jate hain, aksar kai mahine baad, taake dekha jaye ke kidney theek nikal rahi hai. Bachon mein follow-up kuch arse tak jaari reh sakta hai, kyunke kidney barhti rehti hai. Meherbani karke theek mehsoos karne par bhi yeh visits na chhorein.

Agar aap ke bachay ko bataya gaya ho

Paidaish se pehle yeh pata chalna ke bachay ki kidney soojhi hui hai fikr ki baat hai. Meherbani karke yaad rakhein ke bohat se bachon mein sojan halki hoti hai aur kidney ko nuqsan nahi pohanchati, aur plan aam tor par paidaish ke baad scans aur baqaida follow-up hota hai. Aap ke bachay ke doctor batayenge ke kya zaroori hai. Shuru ke mahino mein kabhi infection se bachao ke liye antibiotics ka aik ehtiyati course tajweez kiya jata hai, aur doctor faisla karenge ke yeh aap ke bachay par lagu hota hai ya nahi. Meherbani karke scans ki tamam appointments rakhein, aur bukhar ho to bachay ko jaldi doctor ko dikhayein, kyunke peshab ka infection bunyadi khatra hai. Dekhein urine infection guide.

Aam sawalaat

What PUJ obstruction is

Each kidney collects urine in a central area called the renal pelvis. From there, urine drains into a thin tube, the ureter, which carries it to the bladder. The place where the pelvis joins the ureter is the pelvi-ureteric junction (PUJ). In PUJ obstruction, this junction is narrow or blocked, so urine drains slowly and the kidney swells (this is called hydronephrosis).

Some PUJ obstructions are mild and cause no harm. Others slowly damage the kidney if they are not treated. The aim of care is to find out which type you or your child has. This guide explains how it is found, the tests, when it can be watched and when an operation is advised. It is written for adults and for parents.

A swollen kidney on a scan does not always mean that an operation is needed. A specialist can tell whether the kidney is draining well enough and working normally.

How it is found

PUJ obstruction is one of the more common reasons for a swollen kidney in babies, and it is often found on a scan during pregnancy. In older children and adults it is found when someone has a urine infection, pain in the side or back, kidney stones, blood in the urine, or when a scan is done for another reason. It is sometimes found by chance in someone with no symptoms at all. It can affect one kidney or, less often, both.

Why it happens

Most often, the junction has been narrow since birth, either because the muscle in the wall does not work properly or because the ureter joins the kidney in an awkward place. In some people, a blood vessel crossing in front of the ureter presses on it. In adults it can also follow a kidney stone, infection, injury or an operation, which leave scarring.

It is not caused by anything a mother did or did not do during pregnancy, and it is not caused by diet or lifting. Please do not blame yourself.

Common signs

Many people, and many babies, have no symptoms. When they do appear, they can include:

• Pain in the side or back, which may come and go and may be worse after drinking a lot of fluid.
• Urine infections, sometimes with fever, vomiting or feeling unwell. In babies, a fever may be the only sign.
• Blood in the urine, sometimes after a minor injury.
• Kidney stones forming in the swollen kidney.
• A lump in the side or tummy, which is seen mainly in babies.
• In young children: poor feeding, poor growth or vomiting.

How it is checked

Your doctor will usually arrange:

• An ultrasound scan, which shows how swollen the kidney is and whether the other kidney is normal. It is safe and painless, and it can be repeated.
• A urine test, to look for infection.
• A kidney function (renogram) scan, using a harmless tracer injected into a vein. It shows how much each kidney is working, and whether it drains well. This is the key test when deciding whether an operation is needed.
• Blood tests, to check the kidneys.
• Sometimes a CT or MRI scan, mainly in older children and adults, to see the blood vessels and the anatomy before surgery.
• Sometimes a scan of the bladder and ureters in babies, to check for reflux (see the vesicoureteric reflux guide).

When it can be watched

Not every PUJ obstruction needs an operation. In many babies, and in some older children and adults, the kidney is working well and the swelling is mild. In these cases the specialist may advise watching, with regular scans and urine tests, because many babies improve with time. This is called watchful waiting. It is a planned approach, not doing nothing.

Watchful waiting only works if the follow-up scans are kept. If the kidney starts to work less well, the swelling increases, infections begin, or pain develops, the plan may change to an operation. Please do not miss these appointments.

Treatment options

An operation is advised when the kidney is not draining or working well enough, when it is getting worse, or when it causes pain, infections or stones. The main options are:

Pyeloplasty works well in most people. Your surgeon will explain the risks, which include infection, bleeding, a stent that causes discomfort and, occasionally, the narrowing returning. Please ask any questions before you agree.

After the operation

Most people stay in hospital for a short time. A catheter and a drain may be used for a few days. If a stent was placed, it will be taken out later. It can cause some urgency, discomfort or blood in the urine while it is in. Scans are repeated afterwards, often several months later, to check that the kidney is draining well. In children the follow-up may continue for some time, because the kidney keeps growing. Please attend these visits even if you or your child feels well.

If your baby has been told about it

Finding out before birth that a baby's kidney is swollen is worrying. Please remember that in many babies the swelling is mild and does not harm the kidney, and the plan is usually scans after birth and regular follow-up. Your baby's doctor will explain what is needed. A preventive course of antibiotics is sometimes advised in the early months, and your doctor will decide whether that applies to your baby. Please keep all scan appointments, and take your baby to a doctor promptly if there is a fever, because urine infection is the main risk. See the urine infection guide.

Common questions