Insertion of double J stent as a therapeutic test in management of adults presenting with loin pain and equivocal ureteropelvic junction obstruction.
OBJECTIVE
To evaluate temporary double J ureteric stenting (TDJS) as a test to diagnose ureteropelvic junction obstruction (UPJO) in equivocal cases.


METHODS
One hundred and nine consecutive adult patients with loin pain and ipsilateral equivocal UPJO (EqUPJO) on radioisotope diuretic renogram (RDR) were enrolled in the present study. All patients underwent TDJS for 3 weeks. According to the response (relief of pain) to TDJS, which was assessed by visual analogue pain score (VAPS), patient preference and further management, patients were classified into five groups: Group Ia non-responders who elected conservative treatment for their condition, Group Ib non-responders who elected intervention, Group IIa responders who elected conservative treatment and Group IIb responders who elected intervention. Last group patients were randomized to either early (Group IIb(1)) or delayed intervention 3 months later (Group IIb(2)). Intervention was in the form of pyeloplasty (24 patients) and endopyelotomy (38 patients). All patients were followed up by measuring VAPS and RDR.


RESULTS
After at least 6 months from management decision, 97 patients were available for evaluation. The VAPS dropped by 21.25% (P < 0.001), 32% (P = 0.004), 2% (P = 0.6), 54% (P < 0.001) and 65% (P < 0.001) in groups Ia, Ib, IIa, IIb1, and IIb2, respectively. On the other hand the T (1/2) of RDR dropped significantly only in groups Ib, IIb1, and IIb2 by a mean of 6.5 min (P = 0.005), 8.02 min (P < 0.001), and 7.3 min (P < 0.001), respectively.


CONCLUSIONS
TDJS in cases of EqUPJO with loin pain is helpful in defining cases suitable for intervention versus conservative treatment.
Osman
Tarek
T
Urology Department, Ain Shams University, Cairo, Egypt. tarekosman77@hotmail.com
Fawaz
Khaled
K
Abdelmaksoud
Alaa
A
Eltahawy
Ihab
I
Safa
Wael
W
El Zayat
Tarek
T
El Sadek
Dahlia
D
El Halaby
Rafik
R
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D011336:Probability; D011474:Prosthesis Design; D011866:Radioisotope Renography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D055815:Young Adult
J Urol. 2000 Sep;164(3 Pt 1):652-6
10953119
J Nucl Med. 2005 Aug;46(8):1317-20
16085588
Abdom Imaging. 1994 Jan-Feb;19(1):78-81
8161913
Urol Clin North Am. 1998 May;25(2):227-49
9633578
Radiology. 1995 Oct;197(1):253-5
7568832
Radiology. 2004 Oct;233(1):41-50
15317951
Urol Clin North Am. 1979 Oct;6(3):529-39
505672
Clin Nucl Med. 2004 Mar;29(3):154-60
15162983
J Urol. 1983 Apr;129(4):711-4
6842688
Ann Nucl Med. 2003 Dec;17(8):663-8
14971608
AJR Am J Roentgenol. 2005 Dec;185(6):1608-14
16304022
Br J Urol. 1992 Feb;69(2):126-31
1537021
Tech Urol. 1999 Dec;5(4):207-9
10591260
BJU Int. 2000 Feb;85(3):308-12
10671888
J Urol. 1985 Jul;134(1):92-6
3892052
Eur J Radiol. 2004 Dec;52(3):320-7
15544912
J Urol. 2003 Oct;170(4 Pt 1):1330-4
14501762
Urology. 2006 Oct;68(4):718-22
17070340