Conservative management of pelvi-ureteric junction obstruction (PUJO): is it appropriate and if so what duration of follow-up is needed?
OBJECTIVE
• To establish whether it is safe to manage minimally symptomatic and asymptomatic pelvi-ureteric junction obstruction (PUJO) conservatively.


METHODS
• In all, 50 patients with PUJO diagnosed with dynamic renography, and monitored with at least two renograms.


RESULTS
• In all, 19 patients were totally asymptomatic, while 31 patients had minimal symptoms at time of diagnosis. • The mean follow-up was 53 months. • During the course of follow-up 10 of the 50 patients deteriorated. • All patients who had asymptomatic renographic deterioration, deteriorated within 2 years of diagnosis. • Eight of the 10 patients that deteriorated needed pyeloplasty and two nephrectomy.


CONCLUSIONS
• Conservative management of patients with minimally symptomatic and asymptomatic PUJO is safe. • Discharging patients could be considered at 2 years from diagnosis, if they remain renographically stable and asymptomatic or minimally symptomatic.
Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. manarmalki@gmail.com
Manar
M
Malki
Kate D
KD
Linton
Rory
R
Mackinnon
James
J
Hall
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D007682:Kidney Pelvis / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D021782:Multicystic Dysplastic Kidney / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D015609:Organotechnetium Compounds; D011859:Radiography; D011866:Radioisotope Renography / Q000379:methods; D019275:Radiopharmaceuticals; D017211:Treatment Failure; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D057832:Watchful Waiting; D055815:Young Adult
D000911:Antibodies, Monoclonal; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C104214:technetium-99m-MAG3-dsFV