The Prognosis of Pyeloplasty for Ureteropelvic Junction Stricture

Park, Kyu Wook; Yoon, Jong Byung

Abstract

Restoration of functional and anatomic changes of kidney in UPJ stricture is one of most important subjects in urology. A clinical observation was made on the 28 cases (29 kidneys) of pyeloplasties for UPJ stricture from Jan. 1976 to Dec. 1981. Of them 20 cases (21 kidneys) were followed up for more than 6 months postoperatively. The following results were obtained; 1. The patients in this series were 22 males and 6 females, and 11 children and 17 adults. The left side was 3 times more frequently affected than the right. They symptoms on admission were mostly flank pain, palpable mass, and etc. 2. Preoperative status of UPJ was; UPJ stricture alone in 20, UPJ stricture with aberrant vessel in 4, UPJ stricture with stone in 3, and UPJ stricture with vesicoureteral reflux in 1 case. 3. Preoperative grade of hydronephrosis was closely related to each other in the functional and anatomic aspects of kidney. In general, children showed relatively more advanced hydronephrosis than adults and the degree of improvement of hydronephrosis postoperatively was similar to each other. 4. Anderson Hynes' method of pyeloplasty in most cases (20 kidneys) and simple pyeloureterostomy in 9 kidneys were performed, and results between both operations showed no difference. But Anderson Hynes' method was more effective in marked hydronephrosis such as giant hydronephrosis and simple pyeloureterostomy in mild hydronephrosis. 5. In cases in which UTI was present preoperatively, postoperative UTI tended more to persist than in those not complicated with preoperative UTI, and in both sides postoperative UTI mostly persisted for 2 months and disappeared within 6 months. 6. The period of nephrostomy and ureteral stent was not directly related to postoperative results, but nephrostomy without ureteral stent relatively showed good results. 7. Postoperative complication was UTI in 2, re-do pyeloplasty in 1 and secondary nephrectomy in 1 case. 8. Improvement Of hydronephrosis continued for about a year after operation. It is recommended that more careful attention should be paid for the first year and be continued to watch for consecutive 2 years.