Successful Open Pyeloplasty for PUJ Obstruction in a 5 Y.O. Female Child with Antenatal Hydronephrosis

Chief Complaints

A 5-year-old female child presented to the Urology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of intermittent right flank pain.

The patient had a history of right antenatal hydronephrosis, detected before birth during routine antenatal ultrasound examination. She later developed intermittent right-sided flank pain due to persistent urinary obstruction.

No other significant medical comorbidities, previous surgeries, recurrent urinary tract infections, or chronic illnesses were documented. There was no reported history of hypertension, diabetes, cardiac disease, respiratory illness, neurological disorder, or known medication allergies.

On examination, the patient was conscious, coherent, oriented, and hemodynamically stable. General physical examination showed no pallor, jaundice, cyanosis, clubbing, lymph node enlargement, or swelling. Abdominal examination revealed a soft, non-distended abdomen with mild tenderness over the right flank and no palpable mass. There were no clinical signs of urinary tract infection or dehydration. Cardiovascular, respiratory, and neurological examinations were within normal limits.

Upon admission to PACE Hospitals, following a detailed clinical assessment, the Urology team evaluated the patient for complaints of intermittent right flank pain, along with a review of her history of right antenatal hydronephrosis.

Computed tomography urography was performed to assess the urinary tract and identify the cause and severity of the hydronephrosis. The imaging findings were consistent with right pelviureteric junction obstruction, resulting in impaired drainage of urine from the right renal pelvis into the ureter.

Routine investigations, including complete blood picture, kidney function tests, blood urea nitrogen, serum creatinine, estimated glomerular filtration rate, urine culture and sensitivity, chest X-ray, and basic metabolic panel, were carried out as part of the preoperative evaluation. These investigations helped assess renal function, identify any infection or metabolic abnormality, and determine the patient’s fitness for surgery.

Based on the confirmed diagnosis, the patient was advised to undergo Right Pelviureteric Junction (PUJ) Obstruction Treatment in Hyderabad, India, with a history of Antenatal Hydronephrosis, under the expert care of the Urology Department.

After a detailed consultation with Consultant Laparoscopic Urologist Dr. Abhik Debnath and the senior Urology and Renal Transplant Surgery team, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach.

Considering the patient’s history of antenatal hydronephrosis, intermittent right flank pain, and radiological findings confirming right pelviureteric junction obstruction, the team assessed the severity of urinary obstruction and the potential risk of progressive renal damage. Routine investigations, including complete blood picture, kidney function tests, urine culture and sensitivity, chest X-ray, and basic metabolic panel, showed acceptable parameters for surgery.

Based on the clinical assessment, imaging findings, and preoperative investigations, it was determined that Right Open Dismembered Pyeloplasty under general anaesthesia was the most appropriate and effective management strategy. This procedure was chosen to remove the narrowed segment, reconstruct the pelviureteric junction, restore unobstructed urinary drainage, preserve renal function, and reduce the risk of recurrent hydronephrosis and further kidney damage.

The patient’s family members were counselled regarding the diagnosis, imaging findings, planned surgical procedure, expected recovery, possible risks, the need for ureteral stent removal, and the importance of postoperative care and regular follow-up.

Following the decision, the patient was scheduled for Right Open Dismembered Pyeloplasty in Hyderabad at PACE Hospitals under the expert care of the Urology Department.

The following steps were carried out during the procedure:

• Patient Preparation and Anaesthesia: After obtaining informed consent and completing the pre-anesthetic evaluation, the child was taken to the operating room. Under strict aseptic precautions, general anesthesia was administered, and the patient was positioned appropriately. 

• Exposure of the Pelviureteric Junction: A small flank incision was made to expose the right kidney and pelviureteric junction. The dilated renal pelvis and obstructed junction were carefully identified. 

• Excision of the Obstructed Segment: The narrowed and obstructed pelviureteric junction was excised while preserving healthy ureteral tissue. 

• Dismembered Pyeloplasty Reconstruction: The ureter was spatulated and reconstructed to the renal pelvis using fine absorbable sutures, creating a wide, tension-free junction to facilitate unobstructed urine drainage. A Double J (DJ) ureteral stent was placed to support healing and maintain drainage. 

• Closure and Completion: Hemostasis was ensured, an appropriate surgical drain was placed, and the wound was closed in layers. The procedure was completed successfully without any intraoperative complications.

The patient had an uneventful postoperative recovery and remained hemodynamically stable throughout the hospital stay. Regular clinical monitoring and laboratory investigations were carried out to assess urine output, kidney function, hydration status, wound healing, and overall recovery.

During the postoperative period, the patient received appropriate treatment for prevention of infection, control of pain and discomfort, maintenance of hydration, protection of the stomach, and nutritional support. The urinary catheter and surgical drain were removed on the third postoperative day after satisfactory clinical progress and adequate drainage.

The patient was gradually started on oral fluids and a normal age-appropriate diet and was encouraged to resume routine activity as tolerated. She was discharged in a stable condition with appropriate postoperative instructions and follow-up advice.

Upon discharge, the patient was prescribed oral medications to help prevent postoperative infection, reduce pain and discomfort, protect the stomach from irritation, and support nutritional recovery. Additional supportive treatment was advised to maintain adequate hydration, promote wound healing, and ensure a smooth recovery following surgery.

The patient’s parents were advised to ensure adequate fluid intake, continue a normal age-appropriate diet, maintain proper wound hygiene, and allow gradual return to routine activities while avoiding strenuous physical activity during recovery.

The patient’s parents were instructed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, severe abdominal or flank pain, vomiting, blood in the urine, burning urination, difficulty passing urine, reduced urine output, wound redness or discharge, or worsening urinary symptoms.

The patient was advised to return for follow-up with the Urologist in Hyderabad at PACE Hospitals after 6–8 weeks for cystoscopy, Double J (DJ) stent removal, and further assessment of recovery and kidney drainage.

This case highlights the successful management of right pelviureteric junction obstruction associated with antenatal hydronephrosis through right open dismembered pyeloplasty. The procedure relieved the obstruction, supported normal urinary drainage, and helped preserve kidney function, with an uneventful postoperative recovery.