PUJ Obstruction & Pyeloplasty Treatment in Buckinghamshire & the Thames Valley
What is PUJ obstruction?
PUJ obstruction is a blockage at the pelviureteric junction — the point where the kidney’s collecting system (the renal pelvis) joins the ureter, the tube that drains urine to the bladder. When this junction is narrowed, urine cannot drain freely and backs up, causing the kidney to swell (hydronephrosis). Left untreated over time, a significantly obstructed kidney can lose function, which is why proper assessment matters.
What are the symptoms of PUJ obstruction?
Some people have no symptoms, and the condition is found incidentally on a scan done for another reason. When symptoms do occur, the commonest is intermittent pain in the loin or side — classically brought on after drinking a large volume of fluid. Other features include recurrent urinary infections, kidney stones, blood in the urine, or occasionally nausea with the pain. Many adults with PUJ obstruction were first identified in childhood and followed up into adult life.
What causes PUJ obstruction?
Most cases are present from birth (congenital), either because the junction itself is intrinsically narrow or because a blood vessel crossing the junction compresses it from outside. It can also be acquired later, following scarring, stones or previous surgery. Identifying which applies — particularly whether a crossing vessel is involved — helps plan the right operation.
How is PUJ obstruction diagnosed?
Assessment usually combines an ultrasound (which shows the swelling), a CT urogram to map the anatomy in detail and look for a crossing vessel, and — importantly — a diuretic renogram (MAG3 scan). The renogram is the key test: it measures how well urine drains from the kidney and how much function that kidney still has, which together determine whether treatment is needed and which kidney is worth preserving.
What are the treatment options?
Treatment depends on whether the kidney is genuinely obstructed and how much function it retains:
- Surveillance — for mild or non-obstructing narrowing with good function, monitoring with periodic scans may be all that is needed.
- Laparoscopic (keyhole) pyeloplasty — the definitive treatment, which I perform. The narrowed segment is removed and the junction reconstructed into a wide, freely draining funnel (a dismembered pyeloplasty). When a crossing vessel is the cause, I reposition the junction away from it. Done laparoscopically, this means small incisions, less discomfort and a quicker recovery than open surgery, with success rates typically reported at over 90%.
- Removal of the kidney (nephrectomy) — considered only when a kidney is so badly affected that its function is negligible and it is causing problems.
Why see Mr Neil Haldar?
PUJ obstruction is reconstructed best by a surgeon who does a high volume of laparoscopic kidney work — and with more than 600 laparoscopic renal operations behind me, that is core to my practice. You get a rapid private assessment, the right diagnostic tests arranged quickly (including the renogram that actually determines whether you need surgery), and minimally invasive reconstruction rather than open surgery, across my clinics in Buckinghamshire and the Thames Valley.
How quickly can I be seen?
A private consultation can usually be arranged within a few days, with imaging and renography organised promptly.
Serving patients across Buckinghamshire, Berkshire, Oxfordshire, West Hertfordshire and London
My clinics are easily accessible from across the Thames Valley, serving patients in London, Buckinghamshire, Berkshire, Oxfordshire and the surrounding counties. Private consultations can usually be arranged within a few days.
I regularly see patients from:
- Buckinghamshire (Amersham, Beaconsfield, Marlow, Gerrards Cross, Denham, High Wycombe, Aylesbury)
- Berkshire (Windsor, Maidenhead, Ascot, Slough)
- Oxfordshire (Henley, Watlington, Thame, Chinnor)
- West Hertfordshire (Tring, Chesham, Berkhamsted, Rickmansworth, Chorleywood, Hemel Hempstead)
- North-West London and the surrounding areas
