Treatment on UPJ Obstructions in Adults: A Report of 30 Cases

Park, Keung Won; Choi, Chang Keung; Jeong, Hee Jong

Abstract

PURPOSE
A ureteropelvic junction (UPJ) obstruction is a congenital anomaly commonly afflicting the pediatric population. However, it is also more frequent than generally appreciated in the adult population. This study was performed to understand the specific characteristics of the clinical presentations, courses and surgical success rate for 30 adults, who required surgery for a UPJ obstruction.
MATERIALS AND METHODS
The medical records of 30 adults (16men, 14women, 18 to 65years old, with a median age of 34years) with a urographically proven, clinically significant, UPJ obstruction, who underwent 30 pyeloplasties between 1993 and 1999 were retrospectively reviewed. All patients were followed up for at least 3 months. An excretory urogram and 99mTc-DTPA renal scan were performed for the majority of patients, pre-operatively and 3 months post-operatively.
RESULTS
The majority of the patients presented with flank pain (83.3%). The diagnosis was frequently delayed with an average duration of symptoms of 22 months. In the excretory urography, 81.5% was predominantly involved in the extrarenal pelvis. Thirteen of the 30 patients had associated urinary abnormalities (6; renal calculi, 2; duplicating system, 2; previous pyelonephritis, 1; horseshoe kidney, 1; ureterovesical junction obstruction). The majority of patients underwent a dismembered pyeloplasty (60.0%). The major cause of the UPJ obstructions was an intrinsic stenosis (53.3%). The success rate depending on the radiological finding was 93.3%.
CONCLUSIONS
The results suggest that a UPJ obstruction in adult has a low bilaterality, a low incidence of vesicoureteral reflux, a high association with a renal stone when compared to children. Although the diagnosis was delayed with an average duration of 22 months since the onset of symptoms, the overall surgical success rate depending on radiologic finding was similar to that for children. The extrarenal pelvis may be one of the influencing factors to a high surgical success rate.