From the Research
Surgery for ureteropelvic junction obstruction (UPJO) is needed when patients have significant symptoms, declining kidney function, or severe hydronephrosis that threatens kidney health, as evidenced by studies such as 1 and 2.
Indications for Surgery
The decision to operate on a patient with UPJO should be based on the presence of symptoms, the degree of kidney function impairment, and the severity of hydronephrosis.
- Significant symptoms include persistent flank pain, recurrent urinary tract infections, and kidney stones due to urinary stasis.
- Declining kidney function is indicated by a split renal function of less than 40% on nuclear renography, as seen in studies like 3 and 4.
- Severe hydronephrosis is defined as grade 3-4 hydronephrosis or worsening hydronephrosis on serial imaging, especially in patients with a solitary kidney.
Surgical Approaches
The most common surgical approach for UPJO is pyeloplasty, which can be performed using open, laparoscopic, or robotic techniques.
- Pyeloplasty reconstructs the ureteropelvic junction to restore normal urine flow, as described in studies like 3 and 5.
- Endourological procedures like endopyelotomy may be considered for less severe cases or in patients who cannot tolerate more invasive surgery.
Patient Selection
The decision to operate should balance the risks of progressive kidney damage against surgical risks, with the goal of preserving renal function and relieving symptoms.
- Asymptomatic patients with mild to moderate hydronephrosis and preserved kidney function may be managed with watchful waiting and periodic monitoring, as suggested by studies like 1 and 2.
- Patients with significant symptoms, declining kidney function, or severe hydronephrosis should be considered for surgical intervention, as recommended by studies like 3 and 4.