Contemporary diagnosis and management of pelvi-ureteric junction obstruction

BJU Int. 2022 Sep;130(3):285-290. doi: 10.1111/bju.15689. Epub 2022 Feb 5.


Pelvi-ureteric junction obstruction (PUJO) is defined as a functionally significant impairment of the flow of urine from the kidney's renal pelvis into the proximal ureter. Symptomatically, the patient may experience flank pain, recurrent infections, stone formation, and impairment of renal function. Although many cases of intrinsic PUJO are diagnosed at birth, a minority of patients may present in adulthood with previously silent disease or develop secondary PUJO to other causes. PUJO is therefore broadly categorised into both primary and secondary PUJO. A wide array of diagnostic scans and tests are available to aid in diagnosing and monitoring patients with PUJO. In patients with compromised renal function or symptomatic PUJO that require intervention, minimally invasive techniques are the 'gold standard' for surgical intervention. This review will detail the endoscopic, laparoscopic, and robotic options available to the urologist practicing in 2021, including the use of autografts and other emerging technologies.

Keywords: #UroTrauma; #Urology; crossing vessel; indocyanine green; laparoscopic surgery; nuclear scan; pelvi-ureteric junction obstruction; robotic surgery; secondary obstruction.

Publication types

  • Review

MeSH terms

  • Adult
  • Humans
  • Hydronephrosis / congenital
  • Infant, Newborn
  • Kidney Pelvis / surgery
  • Laparoscopy* / methods
  • Multicystic Dysplastic Kidney
  • Ureter* / surgery
  • Ureteral Obstruction* / diagnosis
  • Ureteral Obstruction* / etiology
  • Ureteral Obstruction* / surgery

Supplementary concepts

  • Multicystic renal dysplasia, bilateral