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Management of uretero-pelvic obstruction in developing countries
V C Onuora1, A H Koko, A N Jasser
1Department of Urology, Riyadh Medical Complex, Saudi Arabia.
Insights
Congenital pelvi-ureteric junction (PUJ) obstruction, often diagnosed via ultrasound, can impair kidney drainage. Early surgical intervention may improve kidney outcomes, especially in regions with limited follow-up care.
Area of Science:
- Urology
- Pediatric Surgery
- Nephrology
Background:
- Congenital pelvi-ureteric junction (PUJ) obstruction is a common cause of impaired renal drainage.
- Increased use of ultrasound has led to more diagnoses of equivocal PUJ obstruction, particularly in children.
- Inadequate surveillance in developing countries poses challenges for managing PUJ obstruction.
Purpose of the Study:
- To evaluate the outcomes of adult patients with congenital pelvi-ureteric junction obstruction.
- To assess the implications of increased pediatric diagnoses of equivocal PUJ obstruction.
- To propose optimal management strategies for PUJ obstruction, considering resource limitations.
Main Methods:
- Retrospective review of 36 renal units in 34 adult patients explored for impaired pelvic drainage.
- Analysis of primary nephrectomy rates and follow-up data.
- Discussion of diagnostic trends and management recommendations based on clinical experience.
Main Results:
- Congenital PUJ obstruction was identified in 29 of 36 explored renal units.
- A primary nephrectomy rate of 8.4% was observed.
- Follow-up data was noted to be poor.
Conclusions:
- Early surgical intervention for pelvi-ureteric junction obstruction may lead to better renal salvage.
- This approach is particularly relevant in developing countries with inadequate surveillance systems.
- Timely management is crucial for preserving renal function in patients with PUJ obstruction.
Abstract:
Congenital pelvi-ureteric junction (PUJ) was found in 29 of 36 renal units explored for impaired pelvic drainage in 34 adults. There was a primary nephrectomy rate of 8.4%, and follow up was poor. The widespread use of ultrasound scan has led to an increase in the number of children with equivocal PUJ obstruction. Where surveillance is inadequate, as is the case in developing countries, we suggest that early operation might lead to better renal salvage in such cases.