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How successful is the conservative management of pelvi-ureteric junction obstruction in adults?

机译：成人骨盆-输尿管结梗阻的保守治疗效果如何？

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OBJECTIVE: To assess the conservative management of pelvi-ureteric junction obstruction (PUJO), according to severity, accepted in paediatric urology but rarely reported in adults. PATIENTS AND METHODS: A series of 23 patients (median age 58 years, 17 men and six women) with asymptomatic or minimally symptomatic PUJO were managed conservatively. The patients' age, preference and comorbidities were considered. The diagnosis of PUJO was based on intravenous urography and isotopic renography. After stringently reviewing the renograms based on relative renal function (RRF) and output efficiency (OE), 15 patients had an OE consistent with definitive PUJO. One patient had no further imaging due to associated comorbidities. Ten patients had right PUJO, three left and one with bilateral PUJO, with unilateral conservative management. The follow-up included annual renography and clinical consultation. Laparoscopic pyeloplasty was considered for patients with a >10% loss of RRF and/or <40% RRF during the follow-up. RESULTS: Overall, 14 of 15 patients had renograms during the follow-up. The mean RRF of the affected kidney at diagnosis was 48.6% which marginally decreased to 46.7% after a median (range) follow-up of 44 (23-75) months. The RRF of 11 patients remained stable and in three decreased significantly (median 11% RRF), requiring pyeloplasty. None of the patients became symptomatic throughout the follow-up. CONCLUSION: In asymptomatic adults the conservative management of PUJO appears to be safe during a short- to medium-term follow-up. We recommend that patients are regularly followed with renography and seen promptly should they become symptomatic. A longer follow-up is needed in a larger group to confirm these findings.
机译：目的：根据严重程度评估小儿泌尿科接受但很少在成人中报道的骨盆-输尿管结梗阻（PUJO）的保守治疗。患者与方法：保守治疗了23例无症状或轻度症状性PUJO患者（中位年龄58岁，男17例，女6例）。考虑患者的年龄，喜好和合并症。 PUJO的诊断基于静脉泌尿造影和同位素肾造影。在根据相对肾功能（RRF）和输出效率（OE）严格审查肾图后，有15例患者的OE与确定性PUJO一致。一名患者由于合并症而没有进一步的影像学检查。 10例患者右PUJO，左3例双侧PUJO，单侧保守治疗。随访包括年度肾脏造影和临床咨询。对于随访期间RRF损失> 10％和/或RRF <40％的患者，考虑进行腹腔镜肾盂成形术。结果：总体上，在随访期间15例患者中有14例有肾图检查。诊断时受影响肾脏的平均RRF为48.6％，在中位（范围）随访44（23-75）个月后略有下降至46.7％。 11名患者的RRF保持稳定，三名患者的RRF显着下降（中位RRF为11％），需要进行肾盂成形术。在整个随访过程中，没有患者出现症状。结论：在无症状的成年人中，在短期到中期的随访中，保守的PUJO处理似乎是安全的。我们建议定期对患者进行肾造影检查，并在出现症状时立即就诊。较大的一组需要更长的随访时间以确认这些发现。

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