A 5-Years Review of Surgical Management of Pelvi-Uteric Junction Obstruction at Federal Medical Centre Bida Niger State.

Abstract

Introduction: Pelvi-ureteric Junction obstruction (PUJO) is a common cause of upper urinary tract obstruction which may result in renal impairment or loss if not diagnosed early and treated promptly. Open surgery remains a mainstay modality of treatment in our centre. We reviewed the patterns of presentation, options of surgical management and outcome in patients with PUJO. Methods: A retrospective study of patientswho had surgical intervention for PUJO from May 2014-June 2019. Demographic characteristics, clinical presentation, investigations, treatment modalities and outcome were collated from clinical notes. Data analyzed on SPSS version 20. Results: A total of 26 patients had surgical intervention for PUJO with mean age of 30.9± 10 years (3-70years), modal age group 31-40, maleto female ratio 1.4: 1. Commonest clinical presentation wasflank pain in 24 patients (92.3%). The PUJO was on the right side in 17 patients (68%), left in 7patients (28%) and bilateral in 2patients (7.7%). Abdominal Ultra sound was done for all patients. Open pyeloplasty 17 (64%) (Dismembered in 14patients (56%), Y-V Plasty in 2 patients (8%), Spiral flap in1patient (3.84%), Percutaneous Nephrostomy tube drainage in 1patient (3.84) and Simple Nephrectomy in 9patients (36%).Stenosed pelvi-ureteric junction, impacted calculus, crossing aberrant vessel, pyonephrosis and thinned- out renal cortex were some of the intra-operative findings. Pyonephrosis and eventual nephrectomy was a morbidity recorded in one patient who had pyeloplasty without stenting. There was no mortality. Conclusion: The goal of surgical management of PUJO is preservation /improvement of renal function hence the need for early diagnosis. Internal stenting in pyeloplasty played a key role in ensuring good surgical outcome.