title: Insertion of double J stent as a therapeutic test in management of adults presenting with loin pain and equivocal ureteropelvic junction obstruction.
abstract: 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.
authors.affiliation: Urology Department, Ain Shams University, Cairo, Egypt. tarekosman77@hotmail.com
authors.forename: Tarek
authors.initials: T
authors.lastname: Osman
authors.forename: Khaled
authors.initials: K
authors.lastname: Fawaz
authors.forename: Alaa
authors.initials: A
authors.lastname: Abdelmaksoud
authors.forename: Ihab
authors.initials: I
authors.lastname: Eltahawy
authors.forename: Wael
authors.initials: W
authors.lastname: Safa
authors.forename: Tarek
authors.initials: T
authors.lastname: El Zayat
authors.forename: Dahlia
authors.initials: D
authors.lastname: El Sadek
authors.forename: Rafik
authors.initials: R
authors.lastname: El Halaby
mesh_terms: 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
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