The CT showed a classic UPJ obstruction. Here is how I plan to evaluate him.
- I ordered a lasix radionucleotide renal scan to determine the degree of obstruction and the degree of function within the kidney.
- If the kidney has good function, I may get an IVP to define the anatomy a bit better.
- Depending on my approach to correct the problem, I may get a CT angiogram to look for crossing vessels, which can complicate certain forms of management.
Now here are his options for treatment.
- Observe: Maybe, if his kidney was not severely blocked. Though I would not recommend this in a young, healthy patient, it might be reasonable in certain situations, in certain patients.
- Endopyelotomy: This is a minimally invasive approach that involves cutting the scarred segment that causes the blockage with an electric knife.
- Pyeloplasty: This is the gold standard with the highest success rates. It is the most invasive.
Lets see what his tests show.