Non-operative management of pelvi-ureteric obstruction (PUJO)
BAUS ePoster online library. Hanah M.
Jun 26, 2018; 211317
Magnus Hanah
Magnus Hanah
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Abstract
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PUJO may be discovered due to symptoms or as an incidental finding and often in the older patient. The classical treatment for adults with renographically proven PUJO is pyeloplasty with high success rates but conservative management may be considered. The indications for conservative management are not clear and guidance is variable. We reviewed the outcomes for patients managed without surgery with PUJO.

Forty-eight patients undergoing non-operative management (mean age 60y) with renographically proven PUJO were reviewed. Renographic follow up up was for a mean of 1.8 years. There were a variety of reasons for conservative management including patient preference and lack of symptoms.

Patients were kept under clinical and radiological review. Surgery was offered if patients became symptomatic or if there was loss of function as determined renographically. The mean relative renal function of the affected side was 44% at diagnosis and was measured at 43% after a mean follow up of 22 months. Of the 48 patients five (10.4%) eventually underwent pyeloplasty. Of the remaining patients who were considered fit for surgery and remained asymptomatic there was no loss of relative renal function nor any need for intervention.

With careful selection, PUJO can be managed conservatively with no adverse outcomes for these patients. A small fraction of patients showed renographic deterioration during surveillance and underwent surgical correction with no disadvantage.
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