Pelvi-ureteric Junction Obstruction Research Articles (Page 1)

A BSTRACT Pelviureteric junction obstruction (PUJO) is typically diagnosed through ultrasound and dynamic renal scintigraphy. This report describes a 5-year-old boy with right flank pain diagnosed as PUJO. Imaging revealed a narrowing at the pelvi-ureteric junction, and a subsequent diuretic renal scan indicated obstructed drainage. During surgery, a second narrowing due to congenital mid-ureteral stenosis was discovered, necessitating an excision of the obstructed ureter segment and pyeloplasty. This report highlights the rarity of Congenital Midureteral Stenosis (CMUS) and the challenges in diagnosing it, especially when it coexists with PUJO. Literature search revealed limited previous reports of this dual obstruction, stressing the importance of careful surgical evaluation in suspected cases of urinary obstruction.

Pelvi-Ureteric Junction Obstruction (PUJO) is one of the most frequent causes of hydronephrosis in both children and adults. It may present with flank pain, vomiting, or progressive renal dysfunction, and if left untreated, may cause irreversible renal damage. Although laparoscopic and robotic techniques are gaining popularity, open pyeloplasty continues to be the gold standard, particularly in anatomically complex cases. A series of three cases of adult PUJO presented here, which were managed with open surgical reconstruction, each with distinct intraoperative findings and outcomes. A 30-year-old male presented with right flank pain and vomiting for two months. Computed Tomography (CT) urography revealed moderate hydronephrosis with a grossly dilated inferomedial calyx, while Diethylenetriaminepenta Acetic Acid (DTPA) scan showed reduced right renal function {24.2%, Glomerular Filtration Rate (GFR) 21.7 mL/min}. Intraoperatively, the dilated lower calyx was compressing a high-insertion ureter. Reduction calycoplasty with infundibular dilatation and Double J (DJ) stenting was performed. Follow-up DTPA showed a 10% increase in split function and +8 mL/min GFR improvement. A 20-year-old female with dull aching left flank pain for one year had a CT urography suggestive of severe hydronephrosis with cortical thinning. DTPA scan showed left kidney function at 18.3% (GFR 16.1 mL/min). Retrograde pyelography confirmed a grossly dilated pelvis. Anderson-Hynes dismembered pyeloplasty was performed, preserving a crossing systemic vein. Follow-up DTPA demonstrated a 10% rise in split function and +10.3 mL/min GFR gain. A 55-year-old female with intermittent right flank pain and vomiting for one year had Intravenous Pyelography (IVP) and Right Retrograde Pyelogram (RGP) suggestive of PUJO due to Pelvi-Ureteric Junction (PUJ) kink with poor drainage. She underwent standard dismembered pyeloplasty. Postoperative recovery was uneventful, and she remains asymptomatic with preserved renal function. In this case series, all three cases were rare and unique presentations of PUJO.

Background: The Double J (D-J) stent is commonly used following A-H pyeloplasty to facilitate the drainage of urine from the kidney to the bladder. One of the most frequent complications associated with the D-J stent is bacterial colonization, which can occur both on the stent itself and in the urine. However, bacterial colonization of an indwelling D-J stent may serve as a nidus for bacteriuria. The aim of this study was to identify the microbiological characteristics associated with stent colonization and urinary tract infection (UTI) in these patients, as well as to determine the drug susceptibility of the microorganisms involved. Methods: This study was conducted in the Department of Pediatric Surgery at Chittagong Medical College and Hospital over a period of twenty-four months, from January 2018 to December 2019. A total of 31 patients with unilateral PUJ obstruction who underwent A-H pyeloplasty were included in this study. D-J stents were placed and left in situ for four weeks. The main outcome variables were UTI, stent colonization, microorganisms cultured from both the D-J stent and urine, and their antibiotic sensitivities. Post-operative follow-ups were conducted at 2 weeks, 1 month, 3 months, 6 months, and 12 months following A-H pyeloplasty, utilizing urine routine microbiological examination (R/M/E) and culture and sensitivity (C/S) tests. Results: There was a total of 31 patients included in this study. The median age was 5 years (IQR: 1.7 years to 7 years), and the male-to-female ratio was 2.44:1. The affected side was right in 14 cases (45.2%) and left in 17 cases (54.8%). One month after the pyeloplasty, 41.9% of cases had positive urinary culture, and the proximal and distal segments of the D-J stent were colonized in 32% and 61.3% of patients, respectively. However, no statistically significant association was found between stent colonization and urine culture. The most commonly identified organisms colonized in both the stent and urine wereEscherichia coli. These cultured organisms were mostly sensitive to nitrofurantoin and meropenem. Conclusion: Bacterial colonization in the D-J stent does not always induce UTI. Escherichia coli was the most frequently identified organism found in both the stent and urine, while nitrofurantoin and meropenem demonstrated high sensitivity against this pathogen. Journal of Paediatric Surgeons of Bangladesh (2021) Vol. 12 (1 & 2):17-23

Purpose: There has been a longstanding debate regarding whether lower pole renal crossing vessels on the pelvi-ureteric junction preclude the need for a dismembered pyeloplasty. A retroperitoneoscopic technique for a transposition of these vessels has not yet been described in the literature. We report our early experience of the retroperitoneoscopic vascular hitch procedure for transposition of lower pole renal crossing vessels, including technique and outcomes. Methods: Single-center retrospective review of all children who had a retroperitoneoscopic vascular hitch procedure for pelvi-ureteric junction obstruction from March 2022 to April 2024. Data on symptom resolution, change in sonographic anterior-posterior diameter (APD), MAG-3 (mercaptoacetyltriglycine) renogram curves, postoperative length of stay, complications, and further surgical interventions were collected. Results are reported as median and interquartile range. Results: Ten patients (70% male, median age 11.7 years, range 8-13 years) with preoperative APD of 34 mm (23-40) over the 2-year period were included. One patient received an on-table diuretic stress test. Seven out of 10 patients had day-case surgery, and 3 patients had an overnight stay. The follow-up period was 343 days (122-456). Postoperative APD was 13 mm (6-23), and the change in APD was -18 mm (-25 to -10). No loss of function or uptake areas on MAG-3 scans were observed. Two patients received antibiotics for a presumed urinary tract infection in the postoperative period. Symptom resolution was achieved in 90% of patients, and 1 patient underwent robotic-assisted dismembered pyeloplasty 10 months later. Conclusion: Retroperitoneoscopic vascular hitch for lower pole renal crossing vessels is an acceptable alternative to dismembered pyeloplasty in selected pediatric cases.

Solitary functioning kidney (SFK) is linked to chronic kidney disease (CKD) in children, particularly when associated with congenital anomalies of the kidney and urinary tract (CAKUT). Pelvi-ureteric junction obstruction (PUJO) is the most frequent obstructive uropathy in SFK. This study aimed to evaluate long-term kidney function in children operated on for PUJO in an SFK. Among a retrospective cohort study of children with an SFK, a subgroup analysis was performed: primary SFK with operated PUJO (n = 35); primary SFK without CAKUT (n = 108); primary SFK with CAKUT other than PUJO (n = 24). Markers of CKD and measured glomerular filtration rate were assessed during follow-up. Surgery was indicated because of neonatal acute kidney injury (AKI) (n = 21), worsening renal pelvis dilation (n = 10). The median age at surgery was 15 months (1.2-30 months). At a median age of 13 years at last follow-up, the proportion of CKD was higher in primary SFK with PUJO compared to primary SFK without CAKUT (43% vs. 12%, p = 0.0008). In SFK/PUJO, neonatal AKI was predictive of subsequent CKD (OR 4.8, p = 0.04). PUJO in an SFK is associated with a high rate of CKD during childhood, particularly when neonatal AKI is present.

Editorial Comment on "A Decrease in Longitudinal Length of Kidney Is a Reliable Tool to Predict the Success of Pyeloplasty in Children"-Sonography in Pediatric Pelvi Ureteric Junction (PUJ) Obstruction.

Eosinophilic pelvi-ureteritis is an uncommon inflammatory condition characterised by eosinophil infiltration in the urinary tract, which can lead to varied clinical presentations ranging from urinary obstruction to reflux. Here, we report the case of a boy in early childhood initially diagnosed with right-sided pelvi-ureteric junction (PUJ) obstruction (PUJO) presenting as an abdominal lump with gross hydronephrosis. The patient underwent laparoscopic pyeloplasty over a double-J stent. Postoperatively, the patient exhibited features of recurrent PUJO after stent removal. The patient was taken up for redo-laparoscopic pyeloplasty, and intraoperatively, a polypoidal growth was identified obstructing the PUJ, which, on histopathological analysis, revealed eosinophilic infiltration. Laboratory evaluation showed peripheral eosinophilia. Medical management with corticosteroids, antihistamines and antihelminthics was initiated. At 1-year follow-up, the patient was asymptomatic with preserved renal function. This case highlights eosinophilic pelvi-ureteritis as a rare cause of recurrent PUJO and underscores the importance of a combined surgical and medical approach for effective management.

There is a paucity of information and data on congenital anomalies of the kidney and urinary tract (CAKUT) in the African setting. The aim of this study was to determine the prevalence, pattern and distribution of CAKUT as observed from computed tomography (CT) scans in a black African population. This was a retrospective study carried out in Enugu, Southeast Nigeria. The study population was drawn from subjects who had an abdominopelvic CT scan or CT urography for either urological or non-urological conditions. Data was pulled from three large-volume referral centers for CT scans in the city center, and study period extended from January 2015 to December 2024. Analysis was performed using Statistical Package for Social Sciences (IBM Corp., Armonk, NY, USA) for Windows, version 27.0. Data were described using frequencies and proportions in tables and charts. The records of 3507 subjects were retrieved for this study. A total number of 122 subjects had congenital anomalies of the kidneys or the urinary tract, which gave a prevalence of 3.5% (95% confidence interval: 2.9-4.1%). The mean age of subjects was 39 ± 19.8 years and the majority of them were males (57.4%). The most prevalent anomaly was pelviureteric junction (PUJ) obstruction (1.28%), followed by duplex collecting system. The prevalence of CAKUT from this study was 3.5%. Pelvic ureteric junction obstruction was the most prevalent congenital anomaly of the urinary tract in our setting.

BackgroundThis study aims to compare the outcomes of double-J (DJ) stenting versus nephrostomy with transanastomotic (NTA) stenting in children undergoing open pyeloplasty, focusing on operative time, complications, postoperative pain, hospital stay, cost-effectiveness, and caregiver satisfaction.MethodologyA prospective, observational study was conducted on 30 children who underwent open pyeloplasty between January 2023 and June 2024. Intraoperative and postoperative parameters were analyzed, including postoperative pain, complications, hospital stay, treatment cost, caregiver satisfaction scores, and postoperative renal function at the six-month follow-up.ResultsThe DJ stent group (Group A) had a significantly shorter operative time (118 minutes vs. 160 minutes, p = 0.0001), lower postoperative pain from 24 to 72 hours (p < 0.05), and higher caregiver satisfaction (8.76 vs. 6.56, p = 0.001). Although the NTA group (Group B) experienced fewer complications, the difference was insignificant (p = 0.45). However, NTA stents were easier to remove (not requiring a second anesthesia) and were more cost-effective (p < 0.0001). No significant difference was observed in postoperative renal function between the groups.ConclusionsThis study highlights that DJ stenting offers better pain control, shorter hospital stay, and higher caregiver satisfaction. NTA stenting may be considered in specific scenarios such as failed DJ stent placement, financial constraints, or large hydronephrotic kidneys where nephropexy is advantageous.

Intraoperative urinary ACR as a prognostic biomarker in unilateral pelviureteric junction obstruction in paediatric population - An observational study.

BackgroundAnderson Hynes dismembered pyeloplasty is the gold standard procedure for management of Pelvic Ureteric Junction Obstruction (PUJO) in children with success rate of 90-95%. The aim of the current study is to evaluate safety, efficacy and outcomes of Anderson Hynes Pyeloplasty in our part of the world. MethodA retrospective study was conducted involving 69 children who underwent Open Anderson Hyne’S dismembered Pyeoplasty over a period of 2 years from March 2022 to April 2024. Patient were evaluated with respect to age, sex, ultrasonographic grading of hydronephrosis, affected side, operation time, postoperative complications and follow-up outcomes and analyzed. ResultThis study consisted of 69 patients with moderate to severe hydronpehrosis secondary to PUJO underwent open pyeloplasty. Male-female ratio was 2:1. Average mean age was 41.67 months (1 month to 156 months) where 28 patients (40.57%) were infants. 45 patients (65.2%) had grade 3 hydronephrosis whereas 24 patients (34.8%) had grade 4 hydronephrosis in ultrasound abdomen. Right sided pyeloplasty was performed in 48 children (69.6%) and left sided was performed in 21 children (30.4%). Mean operative time period was 92.5 minutes with mean hospital stay of 3.53 days (3 days to 5 days). Post-pyeloplasty, 63 patients (91.3%) showed improvement in ipsilateral kidney function on DTPA scan and three patient developed anastomotic stricture which required Re-do Pyeloplasty. ConclusionAnderson Hyne’s dismembered pyeloplasty has shown better outcome amongst pediatric patient with PUJO. It has a high success rate with significant improvement in kidney drainage function.

A decrease in smooth muscle cells at the pelvi-ureteric junction (PUJ), along with abnormal muscle orientation, collagen deposition, and a reduction in Cajal cells, is proposed as the primary cause of obstruction at the PUJ. The findings on histology and the density of interstitial cells of Cajal (ICCs) in patients operated for pelvi-ureteric junction obstruction (PUJO) show variable observations. Clinicians often face a dilemma during the diagnosis and management of patients with PUJO. Hence, to address this knowledge gap, a study of the detailed microanatomy of PUJOand the number of ICCs has been undertaken. A correlation of these parameters with preoperative renal function will help clinicians during postoperative follow-up and prediction of the surgical outcome. The study was carried out on resected specimens from all 54 patients who underwent surgery for PUJO during the study period. The gross features were noted, and bits were taken from the obstructed middle part of the PUJ and the normal distal surgical margin (DSM). The sections were stained with routine hematoxylin and eosin (H&E), Masson's trichrome for collagen, and immunohistochemistry using the c-Kit antigen for ICCs. The study showed a male preponderance of PUJO and antenatal detection in 36 (66.7%) cases. Histological evaluation on H&E staining revealed a narrowed ureteric lumen, a lining epithelium that was either thickened or normal, hypertrophied smooth muscle, and increased fibrosis, most prominently at the PUJ. In some cases, the wall showed increased vascularity, lymphocytic infiltration, prominent nerve bundles, muscle hypertrophy, and fibrosis. These findings were more marked at the obstructed segment. In a few cases, the wall showed atrophied smooth muscles and severe perifascicular fibrosis, which was more prominent at the PUJ. There was a significant difference in the thickness of the lamina propria and muscle layer at PUJ and DSM in the older age group. Masson's trichrome stain is useful for detecting and grading fibrosis at the PUJ due to its differential staining properties. It showed higher grades of fibrosis in the obstructed segments of PUJ and older patients. The ICCs were reduced in the obstructed segment of PUJ as well as the DSM in a majority of the patients. Few patients had normal ICCs at the PUJ and surgical margins. There was a strong correlation between low renal function on nuclear scan, grade 4 fibrosis on Masson's trichrome stain, and absence of ICCs on c-Kit-stained slides. On histological examination, the PUJ showed a narrow lumen, severe grades of fibrosis, muscle hypertrophy/atrophy, and low to absent ICCs, which correlate with severe obstruction and reduced renal function. Age is an important factor in the progression of the disease, and significantly higher grades of fibrosis were noted in older patients. Regular follow-up with USG and renal scan for recurrence of obstruction in the early postoperative period is of prime importance.

Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) often results in renal failure. Alhough the pathophysiology of CAKUT is still not completely understood, several maternal risk factors have been identified associated with children with CAKUT so far. Therefore, the aim of this study was to assess the proportion of risk factors of mothers gave birth to the infants with CAKUT. This cross-sectional study was conducted over a six-month period in the Departments of Pediatrics, Pediatric Nephrology, Neonatology and Pediatric Urology in Dhaka Shishu Hospital, Bangladesh from May 2018 to November 2018. A total of 200 infants aged ≤60 days and with a confirmed diagnosis of CAKUT were included in this study. Informed ascend was taken from the parents of the child. A semi-structured questionnaire was used for data collection, and statistical analysis was performed using SPSS version 21.0. This research was undertaken in conjunction with the ethical principles of Declaration of Helsinki. The mean age of the infants with CAKUT was 22.25±15.08 (SD) days with a male to female ratio of 1:1. The presenting anomalies were primary vesico-ureteral reflux (38.0%), pelvi-ureteric junction obstruction (20.0%), agenesis of the kidney (16.0%), posterior urethral valve (12.0%), dysplasia of the kidney (10.0%) and multicystic dysplastic kidney (3.5%). The most common pregestational risk factors were overweight (76.0%), diabetes mellitus (32.5%) and hypertension (29.5%) among the mothers. On the other hand, oligohydramnios (87.5%), gestational diabetes mellitus (67.0%) and gestational hypertension (45.5%) were the most frequently identified gestational risk factors. Pregestational overweight in women, maternal diabetes and oligohydramnios were most commonly identified risk factors among the mothers of CAKUT infant.

BackgroundThis study examines the correlation between magnetic resonance imaging (MRI)-derived volume parameters, surgical outcomes, and renal function in adults undergoing ureteropelvic junction (UPJ) obstruction surgery. Understanding these relationships can improve surgical planning, patient selection, and postoperative prognosis.PurposeTo assess the correlation between anatomical parameters and surgical outcomes in adult patients with UPJ obstruction.Material and MethodsA prospective cross-sectional study was conducted on 60 patients with UPJ obstruction, selected via simple random sampling. The hydronephrosis volume (HV) to renal volume (RV) ratio was calculated using MR urography (MRU). Preoperative diethylene triamine pentaacetic acid (DTPA) differential renal function (DRF) and creatinine levels were also recorded. Patients requiring surgery were followed up after 6 months, measuring pelvis/RV ratio, creatinine, and DTPA DRF. Statistical analyses were performed to find correlations.ResultsOperated patients had a higher preoperative HV/RV ratio (AUC=0.914, 95% confidence interval [CI]=0.829-1.000; P <0.001) and higher DTPA DRF values (AUC=0.936, 95% CI=0.860-1.000; P <0.001). Patients with greater preoperative HV/RV ratios were less likely to achieve anatomical normalization. Significant correlations were found between HV/RV ratios with DTPA DRF and creatinine (P <0.05). DeLong's test showed no significant differences between HV/RV ratios and DTPA DRF in predicting surgical need.ConclusionQuantitative volumetric analysis using MRU can effectively predict the need for surgery and renal function deterioration in patients with UPJ obstruction. The HV/RV ratio plays a crucial role in guiding surgical decisions and predicting outcomes. This study emphasizes and tests the hypothesis that higher degree of hydronephrosis correlates with higher degree of deterioration of renal function and need for surgical intervention.

To compare the surgical outcomes between non-reduction and reduction pyeloplasty in the management of pelvi-ureteric junction obstruction among patients such as postoperative functional outcomes, complication rate, and failure rate through a meta-analysis of comparative studies. Electronic databases including PubMed, EMBASE, Scopus, and Cochrane Library, including the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched to identify published literature comparing reduction and non-reduction pyeloplasty in adult and paediatric patients. Data on anteroposterior pelvic diameter (APPD), differential renal function (DRF), and complications were extracted. Data synthesis and statistical analysis were done using ReviewManager. Random-effects model and standard mean difference (SMD) were used for calculation of all effect estimates with 95% confidence intervals (CIs) for extrapolation. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO:CRD42021288645). Five studies were selected for analysis, encompassing 177 renal units, of which 88 cases were reduction pyeloplasty and 89 cases were non-reduction pyeloplasty. Continuous variables were presented as SMDs with their 95% CIs. Our overall pooled effect estimates showed a statistically significant difference favouring reduction pyeloplasty in terms of postoperative APPD (SMD 1.77, 95% CI 0.43-3.10) and change in APPD (SMD 1.21, 95% CI 0.07-2.36). No statistically significant difference was observed for postoperative DRF (SMD 0.27, 95% CI -0.10 to 0.64) and change in DRF (SMD 0.68, 95% CI -0.39 to 1.74). Subgroup analyses revealed no statistically significant difference for all functional outcomes. Analysis of both groups revealed no significant difference in terms of postoperative complication rate (relative risk [RR] 0.91, 95% CI 0.38-2.16) and failure rate (RR 1.50, 95% CI 0.28-8.04). The evidence suggests that non-reduction pyeloplasty results in comparable postoperative DRF and change in DRF. Although reduction pyeloplasty results in superior APPD and change in APPD compared to non-reduction pyeloplasty, these findings may be clinically negligible. Complication and failure rates between the two groups are comparable.

Haemorrhagic cystitis ranges in severity from a transient condition to a life-threatening condition which may quickly resolve or require intervention on a priority basis. It is characterised by bleeding from the bladder mucosa and diffuse inflammation. Case of fungal haemorrhagic cystitis with secondary Pelviureteric Junction Obstruction (PUJO) is relatively rare. Hereby, the authors present a case of 57-year-old male who presented to Emergency Department with painful haematuria and increased frequency of micturition, found to have bladder clots and right secondary PUJO on diagnostic investigation. Clot evacuation and bleeder fulguration with right Double J (DJ) stenting was done. Urine culture and sensitivity report was suggestive of budding yeasts. Uncontrolled diabetes mellitus, with an HbA1c of 8.1%, could explain it. He was discharged on postoperative day two with oral cephalosporins and oral antifungals with Foley catheter in-situ. It was followed by Diethylene Triamine Penta Acetic Acid (DTPA) scan 15 days later, which revealed an enlarged, poorly functioning hydronephrotic obstructed right kidney with Glomerular Filtration Rate (GFR) of 5.7 mL/ min, and satisfactorily functioning hydroureteronephrotic left kidney with GFR of 54.6 mL/min. Right open simple nephrectomy was done through the 11th rib flank incision to prevent future complications. Haemorrhagic cystitis should be kept as a differential diagnosis in patients with haematuria not responding to conservative management with multiple co-morbidities. Management of underlying cause remains the key to treatment.

BackgroundUreteral duplication is one of the most common anomalies affecting the genitourinary system. A broad spectrum of clinical presentations and involvement leads to challenges in diagnosing and treating pediatric urologists. Among the variations commonly encountered are incomplete and complete ureteral duplications with normally developed renal moieties and ureters. In this study, we report our experience regarding this spectrum of anomalies in terms of clinical presentation, workup, and management.MethodsThis study was conducted as a single-center retrospective study at our institution from January 2019 to January 2021 on children diagnosed with ureteral duplication anomalies. preliminary renal ultrasonography (RUS) and baseline serum urea and creatinine were done for all patients. This was followed by voiding cystourethrography (VCUG) and magnetic resonance urography (MRU) for anatomical definition as needed and dimercaptosuccinate (DMSA) renal scintigraphy for functional decision.ResultsThis study included 28 children diagnosed with renal duplex anomalies. Of our 28 patients, 4 had ectopic obstructing megaureter with dilated upper moiety segment (3 left-sided, 1 right-sided), 6 had lower moiety refluxing ureter (4 left-sided, 2 right-sided), and 3 had refluxing ureter in upper and lower moieties (para-ureteral diverticulum). Lower moiety pelviureteric junction obstruction was diagnosed in only 1 case. 13 cases were diagnosed with ureterocele obstructing the upper moiety segment (9 left-sided, 4 right-sided), of which 2 presented early with dysplastic upper moiety in 1 and dysplastic whole kidney in the other, and 4 were cecoureterocele and prolapsing through bladder neck obstructing the bladder outlet. One duplex system was found to drain in the bladder with a single ureteric opening, indeed a rare anatomical variant (incomplete duplex).ConclusionUreteral duplications, ectopia, and ureteroceles are uncommon, widely variable, and challenging clinical entities. Since there is no standard management protocol, a conservative approach is worth consideration. A thorough, detailed imaging study is key to delineate anatomical variations. Our chosen bottom-to-top approach proved successful in recruiting functional upper-moiety nephrons. Ureteroureterostomy and laparoscopic upper moiety heminephroureterectomy are both safe and feasible procedures in properly selected cases.Clinical trial numberNot applicable.

Background: Radionuclide scanning for the functional assessment of kidney is a very helpful procedure. 99mTc DTPA renogram with diuretic challenge can evaluate the improvement or decline of individual renal function and GFR at pre operative and postoperative period in case of pelviureteric junction obstruction (PUJO). Patients and methods: This prospective, longitudinal study was carried out among 25 patients with age ranging from 4 to 57 years at Institute of Nuclear Medicine and Allied Sciences (INMAS), Mohakhali who were referred for the estimation of pre and post pyeloplasty renal status. Results: Mean age of study subjects were 24.54±17.96 years with male predominance (56 %). Left kidney was mostly affected (68%). The pre and post pyeloplasty parenchymal and excretory functions were compared and found to be improved about 56% parenchymal and 64 % in excretory functions respectively. Pre-operative mean glomerular filtration rate (GFR) was 33.49 ± 22.40 ml/min which improved to 44.81 ±25.99 ml / min (33.80%) postoperatively. Conclusion: Comparison of pre pyeloplasty and post pyeloplasty renal status by 99mTc DTPA renogram with diuretic challenge appears to be an authentic and beneficial work up that causes very little radiation exposure to patients but provides important clinical clues for further management and follow up. Bangladesh J. Nuclear Med. 28(1): 105-108, 2025

Robotic pyeloplasty for ureteropelvic junction obstruction is widely being done, but for anomalous kidneys, it is a bit challenging due to abnormal anatomy. The ectopic kidney lies outside renal fossa so the operative challenges it poses are a malrotation kidney, associated vascular anomalies, and short ureter complicating not only access but also the reconstruction. We present a case of right ectopic kidney with gross hydronephrosis due to pelvic ureteric junction obstruction. We further discuss the surgical challenges faced during its management and further outcome.

Background and Aims: Renal transplantation remains a crucial treatment for end-stage renal disease, though post-operative complications such as ureteral obstruction can jeopardise graft survival. Methods: Here, we report a case of a 52-year-old male with IgA nephropathy who developed ureteric complications following an ABO-compatible renal transplant. Results: Despite successful induction therapy and initial discharge with stable graft function, the patient experienced recurrent infections, suture site leakage, progressively worsening hydronephrosis and graft dysfunction. Imaging and nephrostomogram identified a pelviureteric junction (PUJ) obstruction with a short, non-functional ureter unsuitable for conventional reconstruction. After detailed evaluation, a Boari bladder flap reconstruction was performed, successfully establishing a direct connection between the bladder and renal pelvis. Post-surgery, the patient demonstrated stable renal function with improved creatinine levels and no complications during follow-up. Conclusion: This case demonstrates the Boari bladder flap’s effectiveness as a practical and efficient method of treating ureteral obstruction in patients with renal transplants whose ureters are impaired in length.