This protocol covers patients with ureteropelvic junction obstruction in whom objective imaging, functional, or symptomatic findings indicate that active surgical management is appropriate rather than continued observation.
Intervention is indicated when one or more of the following criteria are present, provided that differential renal function is at least 10%:
Surgical reconstruction of the ureteropelvic junction is the established treatment in this setting. The full protocol specifies which operative technique and access method apply, and outlines the anatomical criteria under which a minimally invasive alternative procedure may be considered instead.
Success is defined as normal drainage from the kidney on renogram at 12 months, together with resolution of hydronephrosis on ultrasonographic scan at 6 weeks.
DOI: 10.1016/j.eursup.2012.01.004
Some indications for surgery include <40% differential function of the hydronephrotic kidney on MAG3 scanning, a >20-mm anterior-posterior diameter of the renal pelvis on ultrasonographic scan, pain, and infection.
The indications for surgical intervention include (1) pain and infection, (2) asymptomatic obstruction with a differential function <35–40% and an APD >19 mm, (3) failure of conservative management resulting in >10% deterioration of renal function, and (4) grade 3 or 4 dilation as defined by the SFU.
Pyeloplasty, the gold standard treatment of a UPJO, may be a dismembered Anderson-Hynes, Culp, or Foley Y-V pyeloplasty.
If drainage from the kidney is normal on a renogram at 1 yr, patients may be discharged from further follow-up.
A renal ultrasonographic scan is obtained 6 wk after pyeloplasty or after stent removal to ensure that the hydronephrosis is resolving.
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