How successful is the conservative management of pelvi-ureteric junction obstruction in adults?

Objective: To assess the conservative management of pelvi-ureteric junction obstruction (PUJO), according to severity, accepted in paediatric urology but rarely reported in adults.

Patients And Methods: A series of 23 patients (median age 58 years, 17 men and six women) with asymptomatic or minimally symptomatic PUJO were managed conservatively. The patients' age, preference and comorbidities were considered. The diagnosis of PUJO was based on intravenous urography and isotopic renography. After stringently reviewing the renograms based on relative renal function (RRF) and output efficiency (OE), 15 patients had an OE consistent with definitive PUJO. One patient had no further imaging due to associated comorbidities. Ten patients had right PUJO, three left and one with bilateral PUJO, with unilateral conservative management. The follow-up included annual renography and clinical consultation. Laparoscopic pyeloplasty was considered for patients with a >10% loss of RRF and/or <40% RRF during the follow-up.

Results: Overall, 14 of 15 patients had renograms during the follow-up. The mean RRF of the affected kidney at diagnosis was 48.6% which marginally decreased to 46.7% after a median (range) follow-up of 44 (23-75) months. The RRF of 11 patients remained stable and in three decreased significantly (median 11% RRF), requiring pyeloplasty. None of the patients became symptomatic throughout the follow-up.

Conclusion: In asymptomatic adults the conservative management of PUJO appears to be safe during a short- to medium-term follow-up. We recommend that patients are regularly followed with renography and seen promptly should they become symptomatic. A longer follow-up is needed in a larger group to confirm these findings.