Rare Presentation of Pelvi-ureteric Junction Obstruction: A Series of Three Cases

Pelvi-Ureteric Junction Obstruction (PUJO) is one of the most frequent causes of hydronephrosis in both children and adults. It may present with flank pain, vomiting, or progressive renal dysfunction, and if left untreated, may cause irreversible renal damage. Although laparoscopic and robotic techniques are gaining popularity, open pyeloplasty continues to be the gold standard, particularly in anatomically complex cases. A series of three cases of adult PUJO presented here, which were managed with open surgical reconstruction, each with distinct intraoperative findings and outcomes. A 30-year-old male presented with right flank pain and vomiting for two months. Computed Tomography (CT) urography revealed moderate hydronephrosis with a grossly dilated inferomedial calyx, while Diethylenetriaminepenta Acetic Acid (DTPA) scan showed reduced right renal function {24.2%, Glomerular Filtration Rate (GFR) 21.7 mL/min}. Intraoperatively, the dilated lower calyx was compressing a high-insertion ureter. Reduction calycoplasty with infundibular dilatation and Double J (DJ) stenting was performed. Follow-up DTPA showed a 10% increase in split function and +8 mL/min GFR improvement. A 20-year-old female with dull aching left flank pain for one year had a CT urography suggestive of severe hydronephrosis with cortical thinning. DTPA scan showed left kidney function at 18.3% (GFR 16.1 mL/min). Retrograde pyelography confirmed a grossly dilated pelvis. Anderson-Hynes dismembered pyeloplasty was performed, preserving a crossing systemic vein. Follow-up DTPA demonstrated a 10% rise in split function and +10.3 mL/min GFR gain. A 55-year-old female with intermittent right flank pain and vomiting for one year had Intravenous Pyelography (IVP) and Right Retrograde Pyelogram (RGP) suggestive of PUJO due to Pelvi-Ureteric Junction (PUJ) kink with poor drainage. She underwent standard dismembered pyeloplasty. Postoperative recovery was uneventful, and she remains asymptomatic with preserved renal function. In this case series, all three cases were rare and unique presentations of PUJO.