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hydronephrosis in left kidney due to puj obstruction
Discussion in 'All Categories' started by asif khan - Jan 7th, 2012 12:29 am.
asif khan
asif khan
i am 22 years old name asif enginnering at iit delhi i got to come to know about this through a fever which continued till one month then i was told that my (sgpt was 52) and spleen was enlarged and have a stone left uretric calculus 9.0mm with left kidney enlarged measuring 152mm and little abdomen pain this was local report and after tha i visit cmc vellore there i was told everything i s settled except the hydronephrosis and there is no uretric calculus but i have question since the calculus did'nt passed through urine then how did it passed i took noculli (suspension of potassium and magnesium citrate with lots of water and neeri tab.....................
i want'' Ur guidance that for which test i should go to confirm my disease and got it corrected and i have already done with ct scan and ultrasonography and ivr test
re: hydronephrosis in left kidney due to puj obstruction by Dr M.K. Gupta - Jan 8th, 2012 11:44 pm
Dr M.K. Gupta
Dr M.K. Gupta
Dear Mr Khan
Your case is little unusual with conflict of reports of investigations. In this case we suggest you to please come with all the investigation and visit our consultant. The hydronephrosis may be due to PUJ obstruction. Repeat IVP in good lab would be helpful. The radiologist doing investigation should be really good.
With regards
M.K. Gupta
re: hydronephrosis in left kidney due to puj obstruction by Marnen - Apr 22nd, 2012 11:26 pm
A lot of people get cfounsed and think that if everything is taken out then it's a total hysterectomy but a lot are mistaken.Total means that both the uterus and cervix are removed. The term hysterectomy refers to the removal of the uterus and may or may not include taking the cervix.It's possible for one to have a total hysterectomy and keep both ovaries and tubes. The cervix is the neck of the uterus and is about the size of a coat button. Sometimes women do keep the cervix if it's o.k. Some ways to have a total hysterectomy are as follows TVH= total vaginal hysterectomyTAH= total abdominal hysterectomyLAVH= laproscopic assisted vaginal hysterectomy If the cervix is kept then it is called a subtotal or supracervical hysterectomy not a partial hysterectomy even if she keeps both ovaries and tubes or not.SAH- Supracervical or Subtotal hysterectomyLSH- Laproscopic supracervical or subtotal hysterctomy or to break down the abbreviations For SAHS=supracervical or subtotalA=abdominalH=hysterectomyFor LSHL=laproscopicS=supracervical or subtotalH=hysterectomyThe thing that people get cfounsed about is the following.If ovaries and tubes are taken it's called a BSO.B= Bilateral- both S=Salpingo- tubes O=Oopherectomy- ovaries . In a few one may have one ovary and tube removed then it would be called LSO for left ovary and tube or RSO for right ovary and tube. In conclusion if one has a vaginal hysterectomy and keeps both ovaries and tubes then it's a TVH=total vaginal hysterectomyIf the ovaries and tubes are not kept then it's a TVH/BSO.Usually there has to be a problem in order for one to have a hysterectomy. It can be cancer, endometriosis, adenomyosis, fibroids, heavy and long or non-stop bleeding, other problems not listed.
re: hydronephrosis in left kidney due to puj obstruction by Praveen Joshi - Oct 14th, 2012 10:14 am
Praveen Joshi
Praveen Joshi
My ultrasound impression is: right renal PUJ calculus 8X9 mm with renal pelvis ballooning.
Kindly Suggest treatment.

Dear Mr Joshi

You need to have some more test and davinci robotic and laparoscopic pyeloplasty is good option.
re: hydronephrosis in left kidney due to puj obstruction by goldi - Dec 12th, 2012 9:28 am
gross hydronephrosis left kidney & puj obstruction

Dear Goldi

The requirement for treatment depends upon the result with the obstruction on the kidney , the presence of complications as well as the degree of patient symptoms . Surgical procedures are available those patients with pain, diminished kidney function or complications in the PUJ obstruction.

Patients not requiring surgery could possibly be managed with surveillance with careful follow-up.

The most typical surgical technique involves excising the PUJ and reconstructing it to take out the blockage. This is performed using laparoscopic surgical procedures at World Laparoscopy Hospital or using a robotic technique with success rates depending on improvement in patient symptoms and x-ray proof unobstruction approaching 95%. Laparoscopy has significant benefits with patient recovery, reduced remedy and shorter hospital stays compared with open surgery when a 10-15cm incision is essential.

Other techniques involves incising the PUJ by using a selection of techniques. In general these have a very lower success than laparoscopic pyeloplasty.
re: hydronephrosis in left kidney due to puj obstruction by Umapati Paul - Feb 6th, 2013 1:09 am
Umapati Paul
Umapati Paul
Dear sir,
I discuss my problem.
Ultrasonogram of whole Abdoman
Impression-Left sided Hydroureteronephrosis(1st diadnostic report)

Digital X-ray of I.V.U
Normally excreting right kidney and hydronephrosis(lt) due to PUJ obstruction(2nd diagnostic report)
Kidneys-LK-10.60cm and 8.19 cm
Rk-10.52cm and 4.60cm
sir, how can I relief it pls inform me as early as possible.

CUET,Chittagong-4349, Bangladesh.
re: hydronephrosis in left kidney due to puj obstruction by Umapati Paul - Feb 6th, 2013 1:22 am
Umapati Paul
Umapati Paul
Accorting to medical diagnostic report
" Normally excreting right kidney and hydronephrosis (left) due to PUJ obstruction

Umapati Paul
CUET, Chittagong, Bangladesh
re: hydronephrosis in left kidney due to puj obstruction by article - Jun 10th, 2013 7:57 pm
I am grateful for the blog post. Much thanks again. Much obliged.
re: hydronephrosis in left kidney due to puj obstruction by Md firdous ali khan - Jun 14th, 2013 1:34 am
Md firdous ali khan
Md firdous ali khan
dear sir my son 11 month old right side puj obstruction give me advice plz sir .

Dear Md firdous ali khan

Your sin need laparoscopic pyeloplasty surgery for the treatment of PUJI obstruction.

With regard

J S Chowhan
re: hydronephrosis in left kidney due to puj obstruction by Mukesh kumar - Aug 3rd, 2013 4:11 pm
Mukesh kumar
Mukesh kumar
Dear Doctor
my son 7 yr old have rt kidney hydronephrosis due to puj obstruction, kindly suggest the treatment. Whether any open surgery r laparoscopic surgery.

Dear Mukesh Kumar

Your son need laparoscopic or da Vinci robotic pyeloplasty. da Vinci robotic surgery has better precision and you can get robotic pyeloplasty performed in World Laparoscopy Hospital.

With regard

J S Chowhan
re: hydronephrosis in left kidney due to puj obstruction by Mukesh kumar - Aug 3rd, 2013 4:12 pm
Mukesh kumar
Mukesh kumar
Dear Doctor

My Son 7 yr old have right kidney hydronephrosis due to PUJ obstruction, Kindly suggest the treatment. Whether any open surgery or laparoscopic surgery.

Dear Mukesh

The development of Robotic Pyeloplasty has reduced the obstacles to learning intracorporeal suturing, which is the main reconstructive step in pyeloplasty. In pyeloplasty, crossing vessels may be encountered when the renal pelvis is approached from the upper ureter. Mobilizing renal artery and vein fully and preserving them during dissection is important. Inadvertent ligation of a crossing artery would lead to infarction of the corresponding lower pole of kidney. In view of these surgical implications, crossing vessels should be identified in the preoperative CT evaluation. In Robotic Surgery the precision is beyond the limit of human hand.

With regard

re: hydronephrosis in left kidney due to puj obstruction by SUNNY - May 2nd, 2014 3:48 pm
Dear sir,
My son 5 months old has been diagnosied for Right Kidney PUJ obstruction after MRI scans and Renal Scans.
It is neccessary to go for voiding Cystou Rethrogram test also.
Being a painful test, can we avoid it before going for surgery if needed.
If so, can we go for laprscopy surgery.
Please Suggest me sir.
Dear Sunny

The treatment of paediatric PUJ obstruction can be considered as medical or surgical.The current consensus is as follows:
Medical Therapy
The timing of surgical correction of hydronephrosis suggestive of ureteropelvic junction (UPJ) obstruction in newborns is highly controversial. Those who support delayed management contend that for most newborns with relatively preserved differential renal function (>35% of differential renal function), hydronephrosis is a relatively benign disease without proof of progression. Renal function does not deteriorate; thus, immediate surgery is not necessary. In a study by Koff and Campbell, approximately 81 of 104 patients were followed for 5 years; 7 (7%) of those patients ultimately required pyeloplasty, and, even in these cases, pyeloplasty successfully restored the differential renal function to predeterioration levels.[30]

Researchers also observed that in 15 of 16 patients with severe hydronephrosis (grade 4 hydronephrosis according to the Society for Fetal Urology [SFU] Guidelines) associated with a differential renal function of less than 40%, spontaneous improvement occurred in the initial obstructive patterns on renal scans, and, for 6 of the patients, it became unobstructed. Similar results were observed with ultrasonography; hydronephrosis disappeared in 6 kidneys and improved in another 6 kidneys.

Thus, the difficulty in determining the indication of surgical management is 2-fold. First, results from ultrasonography and diuretic renography to assess hydronephrosis can be inaccurate and sometimes misleading. Second, some significant cases of hydronephrosis are discovered by these modalities may not be obstructive at all. Therefore, Koff redefined obstruction as "any restriction to urinary outflow, which if untreated will injure the kidney" to provide a clinically useful guideline; Koff recommended that most unilateral hydronephrosis actually is unobstructed and, thus, benign, which can be observed safely nonoperatively.[31]

While there is debate over antibiotic prophylaxis in mild hydronephrosis, most authors agree on the need for prophylaxis in UPJ obstruction with severe hydronephrosis (SFU grade 3 or 4)

Recommendations for surgical interventions:

Ipsilateral UPJ obstruction with less than 40% of differential renal function on diuretic renograms
Bilateral severe UPJ obstruction with renal parenchymal atrophy
Obstructive pattern on diuretic renograms with abdominal mass, urosepsis, or other symptoms (eg, cyclic flank pain, vomiting)
Recurrent UTI under antibiotic prophylaxis
Patients with renal function better than 40% are monitored with repeat renal scans at 3- to 6-month and 12-month intervals, and surgery is performed only if a clear deterioration in renal function is present. In cases in which the differential function is less than 10%, some recommend the insertion of a nephrostomy tube to determine whether return of function will be sufficient; however, the disadvantages of nephrostomy are inevitable bacteriuria and the practical difficulty of maintaining a tube in an infant. Performing nephrectomy is rare in UPJ obstruction; however, if the differential function is less than 10%, nephrectomy can be considered to relieve recurrent infection or renal hypertension.


With Regards

Dr J S Chowhan

World Laparoscopy Hospital
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re: hydronephrosis in left kidney due to puj obstruction by Nice Laparoscopic Blog - Jul 4th, 2014 6:47 am
Nice Laparoscopic Blog
Nice Laparoscopic Blog
Thanks a lot for the blog post. Really Cool.
re: hydronephrosis in left kidney due to puj obstruction by shubhangi sharma - Sep 22nd, 2014 12:08 pm
shubhangi sharma
shubhangi sharma
Dear Sir

After pregnancy with twins on 11/06/14 got mild hydronephrosis in Right Kidney due to PUJ. RK size 10.6 cm-5.4cm and LK 10.4-5.6cm. Even after 3 months it didnt go away. Kindly suggest.

Pyeloplasty is required in this situation to treat PUJ obstruction.
re: hydronephrosis in left kidney due to puj obstruction by Rubel - Nov 17th, 2014 4:18 pm
Dear doctor,
I younger brother age 22 years, 10 years ago in 2004 we visited a urologist in chittagong bangladesh, and he recommended us a lot of advice one of I.V.U as arrange a surgery as per doctors requirement.

after 10 years my brothers physically feel weak and go to a MBBS doctor and recommended to do Ultrasonography of PUG,,,after getting report..comments: hydronephrosis in left kidney due to puj obstruction,.

pls sir advice what can we do...if need further surgery or avoid surgery how can recover,.

Dear Rubel
Your brother's one kidney is getting hydronephrotic because of PUJ Obstruction. As the disease is 10 yrs old we have to assess the functional status of the kidney. This can be done by Dynamic DTPA Renal scan. If the kidney function is good Laparoscopic Pyeloplasty can be done. You may consult a urologist for evaluation and advise.

With Regards
Dr J S Chowhan
re: hydronephrosis in left kidney due to puj obstruction by A. Raj - May 2nd, 2015 6:07 pm
A. Raj
A. Raj
my wife pregnant of 9months during the scaning revealed that fetal severe left hydronephrosis with ballooning of renal pelvis? PUJ obstruction. Pls what is the remady

Dear Raj,

Pyeloplasty is required after birth so please consult a pediatric surgeon.

with regards
re: hydronephrosis in left kidney due to puj obstruction by Harjit - Feb 2nd, 2016 7:22 pm
My age is 66. Hydronephrosis pelvis of left kidney is dilated 65#43mm, have no pain, Tell me the treatment.

Dear Harjeet,

Hydronephrosis is usually caused by another underlying illness or risk factor. Causes of hydronephrosis include, but are not limited to, the following illnesses or risk factors:

Kidney stone
Congenital blockage (a defect that is present at birth)
Blood clot
Scarring of tissue (from injury or previous surgery)
Tumor or cancer (examples include bladder, cervical, colon, or prostate)
Enlarged prostate (noncancerous)
Urinary tract infection (or other diseases that cause inflammation of the urinary tract)

Hydronephrosis is usually treated by addressing the underlying disease or cause, such as a kidney stone or infection. Some cases can be resolved without surgery. Infections can be treated with antibiotics. A kidney stone can pass through by itself or might be severe enough to require removal with surgery.

You should consult a urologist and get some more investigation to know about the cause of your hydronephrosis.

With regard

Dr Nidhi

re: hydronephrosis in left kidney due to puj obstruction by subhashini swaminathan - Oct 13th, 2016 12:15 pm
subhashini swaminathan
subhashini swaminathan
Dear sir,
I would not be able to come directly as We are living in sydney, Australia. Need online medical advice Please.
My daughter diagnosed with left sided hydronephrosis (PUJ obstruction)antenatally and we decided to delayed management of surgical correction.She is 3years and 10months old now and she doesnt have any kind of problems such high fever , vomiting & pain, UTI so far.

here are latest scan report on 19/09/16,(comparison 16/05/13)

US abdomen report:
The right kidney measures 7.3cm
The left kidney measures 9.1cm and has normal echogenicity. This is marked hydronephrosis with a 31mm renal pelvis (improved compared to previous imaging of 62mm)and 41mm in the extra renal pelvis.There has been interval growth of the kidneys.The urinary bladder outlines normally. the distal ureters are not dilated.

Renal scan MAG3 report:

The two kidneys were normal in perfusion. Their cortical outlines were regular,but the left renal cortex was elongated around a moderately dilated calyceal system,Excretion was traced inside both kidneys by 1-3min normally then tracer filled and was retained in the left pelvicalyceal system while it descended the right ureter into the bladder freely with near complete clearance from the right upper tract.
Differential renal function:left kidney 42% Right kidney 58%(previously on 06/13 left 46% right 54%)
on this occasion, there was an improvement of the left kidney lasix response viz.there was partial clearance when there was nil in the previous scan.After frusemide 1mg/kg IV was given, there was further filling and ballooning of left pelvicalyceal tracer extending down into a very dilated and bulbous extra-renal pelvis;in contrast there was complete wash out of tracer from the right upper tract.
Renal lasix half-clearance time :left 60.1min Right 6.2min

I just typed everything here from the scan report.
My question is ..
Is it worth for further waiting to disappear obstruction naturally without surgery?
Does Renal scan safe for child? She already had 3 times so far.

Thanks in advance.

Dear Subashini
It seems like your child condition is improving day by day so it be worth to wait to be cured by the medicine don't rush for the surgery. If problem like fever, abdominal pain, UTI develops then we can plan for the further intervention. You will need to go for the scan to find out the current status so it is ok.

With Regards
Dr Rahul
re: hydronephrosis in left kidney due to puj obstruction by Sreekanth - Jun 26th, 2018 1:36 pm
Hi Sir,

My son has 4 months old and he had urine infection. So we went doctor and taken the the antibiotic course and he is doing good now. We also US scan and we see some impression like as below.
Exogenic bilateral kidneys evidence of medullary calcification - suggestive of mild left sided nephrocaclcification / hydronephrosis . Mildly thickened urinary bladder wall.
So please let ne know is my son required any further test or treatment needed.

Dear sir
Please consult urologist.
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