UPJ obstruction

In many children, there is functional narrowing at ureteropelvic junction causing pain in flank region or progressive deterioration of kidney function. Often this is diagnosed early in life bur some times diagnosis may happen only in early adulyhhood.

Surgery for UPJ obstruction are

• Open Pyeloplasty:In children, the obstruction is relieved by excision of tight segment of UPJ and then restoring the continuity by ureteropelvic anastomosis over a stent. This is done by a small incision at subcostal region.
• Laparoscopic pyeloplasty:In relatively grown up children or adolescent the surgery can be done laparoscopicaly offering better cosmesis and less pain and hospital stay.
• Vesico ureteric reflux:Many children present as recurrent bout of urine infection in their early childhood. Often on evaluation, it is found because of reflux of urine in ureter and kidney due to incompetent valve at vesico ureteric junction(VUR).

Surgery for VUR

• Sting Procedure (DEFLUX):A silicon gel material is injected at ureteric meatus to partially obliterate the lumen so that reflux is prevented without causing obstruction to urine flow. The procedure can be done endoscopically thus patient can be discharged on next day and there is no operative scar.
• Ureteric reimplantation:Here, ureter is disconnected from bladder and reanastomosis is done with care to produce a tunnel so that reflux can be prevented. The procedure can be done either by opening the urinary bladder or extravesical.
• Hypospadias ( Urethral defect):In some children, the part of urethra is underdeveloped causing urethral opening at undersurface of penis. Often there is fibrosis at the site of undeveloped urethra causing curvature of penis (chordee).