In this informative video, Dr. Koushik Herle, Consultant Paediatric and Neonatal Surgeon at Manipal Hospital Sarjapur Road, ...

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Periureteric Junction Obstruction I Dr. Koushik Herle I Manipal Hospital Sarjapur Road

[Music] hi I'm Dr Kik I'm consultant pediatric surgeon and a pediatric urologist at manipal hospital sarjapur road I'll be talking about a condition called pelv Uric Junction obstruction pelvis means the it is related to the kidney the part of the kidney which connects to the tube where it carries the urine down to the BL ladder that part is called as pelvis and the tube which carries the urine is called the uror developmentally when the baby is being formed in the mother's womb these two are separate structures and then they join together The Junction at which the pelvis meets the uror is called the pelv URC Junction during the development of the baby in the mother's womb there can be small little accidents in the terms of uh defects or congenital defect where this area is narrower compared to rest of the pelvis and the tube because of this narrowing the urinary flow from the kidney into the uror can get obstructed you can imagine this to be like a dam in a canal where it is regulating or blocking the flow of water therefore there's lot of urine which gets collected within the kidney causing it to swell this is called as hydron nephrosis this is an image which shows hydron nephrosis this is the kidney this portion which is bulged is called the pelvis and the tube down is called the uror pelvis joins the uror at a place called as pelv URC Junction this place if it is narrowed down then the condition is called as pelv Uric Junction obstruction because there is an ruction the urinary flow from the kidney into the Ura is blocked or reduced and the urine starts collecting within the kidney causing a swelling and this is called as hydron nephrosis when is pelv ectric Junction obstruction most commonly detected mostly puj obstructions are detected during pregnancy itself when the mother under goes the antinal anomaly Scan they would have mentioned it as hydron nephrosis of whatever the degree present these conditions are usually followed up and Post delivery as a pediatric urologist I would follow these cases and order a few tests now what are the tests that we do an ultrasound to see what is the degree of hydron nephrosis that is the degree of swelling a nuclear medicine scan called as dtpa scan or an EC scan is done this is usually done at 1 month of age and this will give give us an idea as to what is the degree or the extent of block is it a complete block or is it a partial block based on these reports we then plan the surgery the surgery for pelvi uric Junction obstruction is important because of these following reasons the kidney once the baby is born has filtering units called nephrons these are fixed just like brain cells as a child grows the nephron number doesn't increase but it only increases in size so when there is hydron nephrosis because of the pressure in the kidney the nephrons can get damaged and this damage is permanent so addressing this is important to prevent future damage and loss of function of the kidney the child can also have urinary tract infections if this condition is not corrected so what is the surgery done the surgery is called as pyop plasty it can be done as both open and laparoscopic but these days it's more commonly done with minimal invasive surgeries that is laparoscopic surgery this involves removal of that small segment which is narrowed and stitching back the pelvis with the Ura so that the caliber or the width of the tube is maintained the stitches are all absorbable there will be a small stent it's a plastic tube which is biocompatible and it will be removed per uretra as in through the uretra itself later after 6 weeks it does not the stent removal does not involve any cuts on the body in the second time pelvic Junction obstruction when detected early we can preserve the kidney function completely and it's a completely correctable condition where the child will have a normal functioning kidney and a good future do consult a pediatric urologist for more on P obstructions thank you [Music]

Dr.

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