Kidney Blockage in Children (PUJ Obstruction): Causes, Treatment & Why Early Care Matters

As a paediatric surgeon, one of the most common causes of kidney-related pain I encounter in children is Pelvi-Ureteric Junction (PUJ) Obstruction. This condition occurs when there is a narrowing at the junction where the kidney meets the ureter, leading to blockage of urine flow. If untreated, it can silently damage the kidney.

In today’s blog, I want to share not just the medical facts but also a real-life case report to help parents and caregivers understand why early identification and timely surgery can make all the difference.

A 7-year-old boy was brought to our clinic with complaints of recurrent episodes of abdominal pain, especially after drinking lots of water or during play. The parents thought it was “gastritis” or “constipation,” but an ultrasound revealed hydronephrosis (swelling of the kidney). Further investigations confirmed left-sided Pelvi-Ureteric Junction Obstruction.

The child underwent a laparoscopic pyeloplasty (the gold standard surgery for PUJ obstruction). Within days, his pain subsided, and follow-up scans showed a well-draining kidney. Today, two years later, he is completely symptom-free, with normal kidney function and enjoying school sports like any other child.

Symptoms Parents Should Look Out For

PUJ obstruction can sometimes be silent, but here are warning signs parents must not ignore:

• Recurrent abdominal or flank pain, often severe and colicky

• Pain triggered after fluid intake or exertion

• Urinary tract infections (UTI), especially recurrent

• A palpable lump in the abdomen (enlarged kidney)

• Rarely, blood in urine (hematuria)

Early recognition is vital because a blocked kidney gradually loses function if untreated.

Why Early Treatment is Essential

• Prevents permanent kidney damage

• Relieves chronic or acute pain episodes

• Reduces risk of recurrent UTIs and sepsis

• Improves long-term renal function and growth

• Enhances overall quality of life

  
  

Treatment Options for PUJ Obstruction

The management depends on the severity of the obstruction and the child’s symptoms:

🔹 Observation – In very mild cases with good drainage, regular follow-up with ultrasound and renal scans may be advised.

🔹 Laparoscopic Pyeloplasty – The gold standard treatment. The obstructed segment is removed, and the ureter is reattached to the kidney pelvis to allow free urine flow. It has excellent outcomes with small scars and faster recovery.

🔹 Open Pyeloplasty – Still performed in selected cases, especially in very young infants or where laparoscopy is not feasible.

🔹 Endopyelotomy/Stenting – Rarely used in children; reserved for selected cases.

Post-Operative Care

• Child usually stays in the hospital for 3–5 days after laparoscopic surgery.

• A small stent (DJ stent) may be placed to keep the ureter open, which is removed after 4–6 weeks.

• Pain relief, early mobilization, and hydration are key.

• Follow-up ultrasound and scans are done to ensure proper kidney drainage.

  
  

Long-Term Outcome

• Success rate of laparoscopic pyeloplasty is >95%.

• Most children lead a normal life with preserved kidney function.

• Rarely, re-obstruction can occur, requiring repeat intervention.

• With timely surgery, the affected kidney continues to grow and function normally alongside the healthy one.

  
  

Key Takeaway for Parents

If your child frequently complains of unexplained abdominal pain, has recurrent UTIs, or an ultrasound shows a swollen kidney, it’s important to consult a paediatric surgeon.Pelvi-Ureteric Junction Obstruction is completely treatable – and early treatment ensures your child’s kidney stays healthy for life.

📌 For Parents: Stay alert to your child’s symptoms. Early diagnosis of PUJ obstruction is the best way to protect your child’s kidney health.

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