Background: A 32-year-old primiparous woman presented with a painful left-sided giant hydronephrotic kidney secondary to pelvi-ureteric junction obstruction (PUJO).
Investigations: Renal ultrasonography, intravenous urography and MAG-3 renography.
Diagnosis: Symptomatic non-functioning left PUJO in first trimester.
Management: Following counselling, the patient had an uncomplicated retroperitoneoscopic nephrectomy at 9 weeks' gestation for symptom relief and to prevent future risks to both mother and fetus during the remainder of the pregnancy. She had an uneventful recovery and delivered a healthy 3.2 kg male at term per vaginum.