Congenital pelviureteric junction obstruction

Case contribution: Dr Radhiana Hassan


  • A 3 years old girl, no known medical illness
  • Had a fall from staircase and brought to hospital with complaint of blood in urine after the fall
  • Clinically no tenderness or bruise
  • BP=92/54mmHg, PR=125 bpm and GCS=15/15
  • UFEME: gross hematuria, presence of leukocytes and protein
  • Renal function test normal, INR normal
  • CT scan to rule out urinary sytem injury
CT scan of abdomen in axial plane, post contrast soft tissue window

CT scan findings:

  • Left kidney is enlarged with gross hydronephrosis (yellow arrows).
  • There left renal pelvis is also dilated. However ureter is not dilated.
  • Right renal is normal in size and no hydronephrosis seen.
  • No evidence of injury. No perinephric collection.
  • Urinary bladder is grossly normal.

Diagnosis: Congenital PUJ obstruction.

Progress of patient:

  • She was admitted and treated for urinary tract infection.
  • Referred to other hospital for further management.
  • Operation done (Anderson Hynes pyeloroplasty). Intra-operative findings of left kidney slightly rotated with pelvis facing anteriorly. Renal pelvis was dilated and thick-walled. PUJ non-dependant and narrowed. Proximal ureter is also narrowed. Distal ureter was normal. Renal parenchymal was good.
  • DTPA was done 5 months after operation that shows good function of both kidneys. No urinary flow obstruction seen. Differential function of left kidney was 52% and right kidney was 48%.


  • Congenital PUJ is by far the most common cause of paediatric hydronephrosis.
  • It is demonstrated as dilatation of pelvicalyceal system with abrupt end at pelviureteric junction. The ureter is usually not dilated and this differentiates it from vesicoureteric reflux.
  • Many cases are asymptomatic and identified incidentally when the renal tract is imaged for other reasons. If symptomatic, symptoms include recurrent urinary tract infections, stone formation or a palpable flank mass.
  • They are also at high risk of renal injury even by minor trauma.
  • It is commonly unilateral and more common in males.
  • There is a recognised predilection towards the left side.
  • Associated renal anomalies include renal duplication, multicystic dysplastic kidneys, horse-shoe kidney and cross fused ectopia.
Author: radhianahassan