For GPs

Referral information

A practical guide for GPs and other referrers on when to suspect pelvi-ureteric junction obstruction, which imaging to request, and what to send with the referral.

Urgent red flags. Severe loin pain with fever, rigors, or sepsis raises concern for an infected obstructed kidney and needs emergency department assessment for urgent drainage (nephrostomy or ureteric stent). Call the on-call urology registrar at St Vincent's or the Mater after patient transfer.

When to think of UPJ obstruction

  • Intermittent loin pain, especially provoked by a high fluid load (classic "beer drinker's" PUJ pain).
  • Recurrent loin pain with normal CT-KUB and no stone, or a stone incidentally noted with an unexpectedly dilated pelvis.
  • Incidental hydronephrosis on an abdominal ultrasound or CT performed for another reason.
  • Recurrent pyelonephritis on one side.
  • Known antenatally diagnosed or childhood PUJ narrowing presenting later in adulthood.

Imaging to organise before referral

Investigations can be arranged before the consultation or at the specialist visit, whichever is easier for the patient. The two core studies are:

  • CT urogram (CT IVP). Confirms the level of the narrowing, measures the renal pelvis, looks for crossing vessels, and excludes a stone or tumour as the cause.
  • Diuretic MAG3 renogram. Quantifies split renal function and, by giving frusemide during the study, confirms whether the dilation is truly obstructive or just baggy. A T½ longer than 20 minutes after frusemide is generally considered obstructive.

An ultrasound can be useful as a first screen but is rarely enough on its own to plan surgery.

What to include with the referral

  • A brief history of the presenting complaint and any previous urinary tract interventions.
  • Relevant comorbidities, especially diabetes, anticoagulant use, and prior abdominal surgery.
  • Most recent UEC / eGFR.
  • Copies or PACS codes for the CT urogram and MAG3 renogram, plus any prior imaging reports.
  • The patient's preferred consulting location (Darlinghurst, North Sydney, or Bowral).

What Dr Kooner offers

  • Robotic-assisted dismembered pyeloplasty (primary reconstruction of choice for most adults).
  • Laparoscopic pyeloplasty for selected anatomies.
  • Open pyeloplasty for patients unsuited to laparoscopic or robotic surgery.
  • Retrograde holmium laser endopyelotomy for shorter narrowings or previously treated patients.
  • Post-operative stent management and MAG3 follow-up at three to six months.

For non-urgent referrals, please call the rooms on (02) 8382 6980 or send the referral to Raji.Kooner@svha.org.au. Provider number and practice details can be supplied on request.

Discuss your UPJ obstruction pathway

The rooms can arrange a consultation to review imaging, confirm obstruction with a drainage study, and outline which pyeloplasty approach fits your situation.

Contact the rooms Second opinion