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Friday, April 20, 2007

The UPJ Obstruction

I saw an interesting case yesterday that I'd like to share with you. A 40 year old man was referred to me, stat, after a CT report showed severe hydronephrosis--swelling--on his kidney. The patient had no pain and was, in-fact, completely asymptomatic. the CT scan was done to evaluate an umbilical hernia.

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.

  1. 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.
  2. Endopyelotomy: This is a minimally invasive approach that involves cutting the scarred segment that causes the blockage with an electric knife.
  3. Pyeloplasty: This is the gold standard with the highest success rates. It is the most invasive.

Lets see what his tests show.

The IU.