Ureteropelvic junction obstruction

Abstract

The primary goal in diagnosing and treating ureteropelvic junction obstruction (UPJO) is to prevent ipsilateral renal function loss. Secondary goals are to minimize associated comorbidities, including the following: 1. fUTI. 2. Pain. 3. Hematuria. 4. Urolithiasis. Summary of evidence for these aims: Extent of HN by either SFU grade or AP diameter does not correlate with renal function. To our knowledge, no study demonstrates that prolonged drainage determined by T1/2, appearance of the curve, or other measurement correlates with renal function or predicts future renal function loss. Most patients have <10 % change in ipsilateral renal function after pyeloplasty. Zero to 39 % of patients observed without surgery have ipsilateral function loss variously described as >5 %, >10 %, or <40 %, but following pyeloplasty, final ipsilateral renal function loss is 0-6 %. No RCT shows benefit for surgery over observation to preserve ipsilateral renal function. Two studies reported resolution of renal colic after surgery. No studies were found documenting impact of pyeloplasty on recurrent UTI, hematuria, or renal stone formation.