Ureteropelvic junction obstruction: long-term followup of adults with and without surgical treatment.

PURPOSE: We compared the long-term outcome of hydronephrosis due to pyeloureteral obstruction based on excretory urography findings and renal function in patients who did and did not undergo pyeloplasty.

MATERIALS AND METHODS: We followed 83 adults for a mean of 17 years after the diagnosis of hydronephrosis. The choice of conservative or surgical management was based on the results of excretory urography, pelvic manometry, fluoroscopy of pelvic and ureteral peristalsis, isotope renography and renal clearance studies but symptom severity was considered greatly important. Three patients not included in the study underwent primary nephrectomy due to poor ipsilateral function, while 47 underwent pyeloplasty and 36 no surgery.

RESULTS: Nephrectomy was later performed in 2 patients each in the pyeloplasty and no surgery group, respectively, because of pyelonephritis and stone formation in 3 and persistent pain in 1. Hypertension developed in 2 cases in each group. Renal pelvic size was considerably decreased after pyeloplasty and dilatation increased in only a few kidneys in the nonsurgical group. Excluding the 4 patients treated with late nephrectomy serum creatinine pathologically increased in only 1 who was treated conservatively. Split function improved from 40.8% to 47.1% of total function after pyeloplasty but the total glomerular filtration rate did not improve significantly.

CONCLUSIONS: In the absence of infection and stone formation hydronephrosis in adults seems to be a fairly benign condition and followup should be directed mainly toward detecting these complications. Recurrent flank pain still seems to be the best indication of the need for surgery.