 I am Dr. Jaitirtha Joshi working as a consultant pediatric surgeon P.U.J. obstruction when you see the urinary system urine produced in the kidney and they will be connected with the urinary bladder where the urine is stored by the pipe called as ureter. So there is obstruction at the level of kidneys in this pipe it is called as P.U.J. obstruction. So how to identify this condition it depends on the age at which it is identified most commonly nowadays with antinatal scanning means when the fetus is in the uterus that time they do regular antinatal scan that time also it can be diagnosed or they may present with the non specific symptoms like pain abdomen pain in the tummy or they may present with the urinary tract infections. So how to diagnose it diagnosis usually by the initially when we evaluate for pain abdomen or anything which is diagnosed antinatal we do the ultrasound then we find there is a swelling in the kidney so it means that there is some obstruction in the upper urinary tract. So to confirm how much obstruction is there we do it is called as a nuclear scan which it will assess the function of the kidney involved kidney and also how much severe is the obstruction is. So after assessing these by these two tests we can do the surgery it can be done either open surgery that means open surgery means we make a incision or the we open the body and then do the surgery or it is also called as keyhole or minimally invasive or also it is called as laparoscopic surgery. So principle of treatment is that we have to take out the whatever the causing obstruction and rejoin the those cut parts so then we again assess at the age of after the surgery may be after six months again with the nuclear scans and to clear that there is obstruction is resolved. So this is a one of the preventable cause of kidney failure in children so if you to treat it appropriate time then we can avoid the complications like stone formation or there may be a pus formation in the kidney or sometimes the kidney may go fail without the notice. So next one condition which I am going to discuss is about is called as vesicoerotric reflux. So first you should understand what is vesicoerotric reflux vesicoerotric reflux means when the kidney produces urine so it comes to the urinary bladder through a pipe called the urator someone voids means micturates so it should empty completely so that there is no residual urine. In the condition called as vesicoerotric reflux when the someone passes urine so around 60 to 70 percent of urine comes out and around maybe around 20 to 30 percent it refluxes back into the kidney causing the problem. So as I discussed earlier it can be diagnosed antinatally but we cannot see antinatally how the urine goes back into the kidney but we can predict so if there is a kidney swelling in the antinatal scans but mainly they present with urinary tract infection repeated urinary tract infections failure to thrive or sometimes they may present at the later stage as a kidney failure. So when you find the children with the history of urinary tract infection or any other symptoms with the fever then they are not feeding well or there is no growth or it is called as growth retardation when you do first in preliminary test that is urine routine where you send may be whenever there is infection you see pus cells in the urine and then you would do the urine culture to identify the organism. Then we have to treat appropriately with the antibiotics then how to confirm whether there is a vascoerotic reflux there are different methods are there how to identify them so most commonly we use called as maturating cystoerotrogram this is a test where you are putting the catheter into the bladder and we put a radiopecti or a medicine which will be seen in the x-ray when child voids we will take the films and we will come to know that the complete urine is coming out or there is a reflux of the urine back into the kidneys. So when this type of reflux is there we again grade it depending upon the how much fever it is and followed by we do again a nuclear scan which will identify if there are any scars are there in the kidneys. So if you identify in the say immediate neonatal period or less than one year usually we keep them on it is called as continuous antibiotic prophylaxis. Continuous antibiotic prophylax means we give small dose of antibiotic every day at the night to prevent the infection sometimes they resolve on their own if the reflux is lower grade means that there is a severity is lesser one. So we can manage like that maybe at the age of five years they resolve but if the children having repeated infections growth retardation and the when we do dmsa renal scans issue the scar then we have to do the surgery surgery means we have to do a surgery in such a way that when a child voids it should not reflux back. So it can be done either open surgery or also called as minimal invasive surgery or laparoscopic surgery. By doing this we can prevent the urine reflux and we can stop the renal or kidney damage then so that child improves and we can prevent the kidney failure in the children and this is one of the leading cause of surgical cause of renal failure in all over the world.