Treatment of Congenital Pelvic Ureteric Junction (PUJ) Obstruction

Diagnosis and Classification

• Congenital PUJ obstruction is one of the most common causes of urinary tract dilation (UTD) detected prenatally, according to the American Academy of Pediatrics 1
• It falls under the category of obstructive uropathies in the classification of causes of urinary tract dilation, as stated by the American Academy of Pediatrics 1
• Diagnosis is typically made through prenatal ultrasound and confirmed postnatally, as recommended by the American College of Radiology 3

Management Approach

Conservative Management

• The majority of patients with PUJ-like UTD will not need surgical correction and can be observed with serial imaging, as suggested by the American Academy of Pediatrics 1, 2
• Conservative management includes regular ultrasound monitoring to assess degree of hydronephrosis, as recommended by the American Academy of Pediatrics 1
• An antenatal anterior-posterior renal pelvic diameter (APD) cutoff of 15 mm has been identified as predictive of the need for intervention, according to the American Academy of Pediatrics 1

Indications for Surgical Intervention

• Increasing hydronephrosis on serial ultrasound examinations is an indication for surgical intervention, as stated by the American Academy of Pediatrics 1

Special Considerations

Antibiotic Prophylaxis

• Continuous antibiotic prophylaxis (CAP) may be considered for patients with high-risk features, such as female gender, intact foreskin with moderate to severe UTD, severe UTD, distal ureteral dilation, and associated vesicoureteral reflux, as recommended by the American Academy of Pediatrics 1, 2
• However, data from the SFU Hydronephrosis Registry showed no benefit for CAP in isolated UPJ-like hydronephrosis, as reported by the American Academy of Pediatrics 1

Pitfalls and Caveats

• Avoid dismissing mild hydronephrosis without proper follow-up as some cases may progress, as cautioned by the American Academy of Pediatrics 1
• Endopyelotomy may be an option for mild to moderate obstruction without complex anatomy, as stated by the American Urological Association, although this fact is from Praxis Medical Insights, an alternative source is not available 4