Experience in the Management of Poorly Functioning Obstructed Kidneys with Confirmed Pelvi-Ureteric Junction Obstruction

Christopher J Johnstone, Agapios Gkentzis, Michael Kimuli, Jon Cartledge, Chirag Patel and Chandra Shekhar Biyani

Department of Urology, Southport & Ormskirk Hospital, UK
Department of Urology, Royal Bolton Hospital, UK
Department of Urology, St James’s University Hospital, UK
Department of Radiology, St James’s University Hospital, UK

^*Correspondance to: Chandra Shekhar Biyani 

 PDF  Full Text DOI: 10.25107/2474-1647.2622

Abstract

Background: The management of obstructed kidneys with poor relative function remains controversial. Guidance is minimal regarding the split function of <25% on renogram. We reviewed the local experience in such cases and explored how interventions affect the final outcome. Patients and Methods: We identified patients with Pelvi-Ureteric Junction Obstruction (PUJO) and <25% split renal function in either kidney post diuretic renography (MAG-3) via the Radiology department database and reviewed their management and clinical outcome. The poor function has been defined as less than 25% based upon the available literature. Respective data was collated for demographics, diagnoses and intervention factor. Results: Ninety-four patients were identified between 2007 and 2014. All of whom had been diagnosed with PUJO by renogram. The median age was 42 years (2-90). Males: 56%. Left kidney (65%). Ninety-four patients had unilateral pathology. Most presented with loin pain (80%). Of those patients who underwent pyeloplasty, they had a laparoscopic procedure. Follow-up (FU) data was available in all patients. Median FU is 24 months. The mean split function at presentation was 20%. 61 patients underwent pyeloplasty, 24 patients were managed endoscopically and the remaining 9 patients were managed conservatively. In total, 7 patients required nephrectomy during follow-up and 3 patients were awaiting elective nephrectomy due to ongoing symptoms of pain and infection. The majority of patients described significant improvements in pain and infection rates at follow up after surgical intervention. Conclusion: In obstructed kidneys with poor function (<25%) on diuretic renography pyeloplasty can maintain function and improve symptoms. This can be of importance in specific patient populations such as those with diabetes or renal disease in whom renal preservation is essential. Conservative management or the long-term use of stents should be reserved for those who are not suitable for more invasive surgery as this group rarely have favourable outcomes in terms of functional benefit or symptom control.

Keywords

Pelvic ureteric junction; Poor function; Pyeloplasty; Nephrectomy

Cite the article

Johnstone CJ, Gkentzis A, Kimuli M, Cartledge J, Patel C, Shekhar Biyani C. Experience in the Management of Poorly Functioning Obstructed Kidneys with Confirmed Pelvi-Ureteric Junction Obstruction. Clin Surg. 2019; 4: 2622..