Bilateral pelvi-ureteric junction obstruction: our experience in a developing country

Area of Science:

• Urology
• Pediatric Surgery
• Nephrology

Background:

• Bilateral pelvi-ureteric junction (PUJ) obstruction is a rare condition associated with significant morbidity and mortality.
• Late presentation is common in resource-limited settings, where open surgery remains the primary treatment modality.
• Diagnosis and management in the perinatal period have advanced, but challenges persist in certain regions.

Purpose of the Study:

• To analyze the clinical features, management, and outcomes of patients with bilateral PUJ obstruction treated at a tertiary hospital in Nigeria.
• To identify the common etiologies and complications associated with bilateral PUJ obstruction in this population.
• To evaluate the effectiveness of open pyeloplasty as a treatment option.

Main Methods:

• Retrospective review of patients diagnosed and managed for bilateral PUJ obstruction between 2006 and 2011.
• All patients underwent open surgical repair, with stenting using double J stents or feeding tubes.
• Surgical procedures included Anderson-Hynes and Heineke-Mirhulicz pyeloplasty.

Main Results:

• Eighteen patients (11 male, 7 female) were analyzed, with a mean age of 27.5 years.
• Common presenting features included loin pain and fever, with hydronephrosis, impaired renal function, and pyelonephritis as major complications.
• Congenital anomalies and schistosomal fibrosis were the primary causes of obstruction. Post-operative complications included UTIs and leakage, with a 5.56% mortality rate.

Conclusions:

• Bilateral PUJ obstruction in Maiduguri is uncommon, with congenital and schistosomal etiologies predominating.
• Aggressive pre-operative management to restore renal function is vital for improving outcomes.
• Open pyeloplasty offers a favorable outcome for bilateral PUJ obstruction, even in cases with late presentation.