Repair of adult ureteropelvic junction obstruction in the solitary kidney: effect on renal function.

OBJECTIVES: To evaluate the effect of pyeloplasty for the treatment of ureteropelvic junction (UPJ) obstruction on adult renal function in the setting of a solitary kidney.

METHODS: Since 1989, 312 patients have undergone operative intervention for UPJ obstruction. Of these, 13 patients (5 men and 8 women), aged 17 to 76 years (median 44.5), had a solitary kidney and were available for postoperative surveillance. Treatment consisted of endopyelotomy (n = 3), laparoscopic dismembered pyeloplasty (n = 3), and open dismembered pyeloplasty (n = 9). Two patients underwent two separate interventions for UPJ obstruction repair. Success was defined as symptomatic relief and radiographic resolution at the latest follow-up visit. In all patients, serum creatinine, estimated glomerular filtration rate, and weight were measured preoperatively, postoperatively, and at all follow-up examinations. Statistical analysis was performed to analyze group differences using the Wilcoxon signed-rank test.

RESULTS: The median follow-up was 22 months (range 2 to 96). Three patients experienced a treatment failure and were excluded from the analysis. At the latest follow-up visit, the postoperative serum creatinine had improved by a median of 0.6 mg/dL (range -0.2 to 6.3; P <0.0001), and postoperative estimated glomerular filtration rate had improved by a median of 24.4 mL/min (range -13.9 to 66; P <0.0001). No statistically significant difference in renal function was observed between the patients' first and last follow-up visits.

CONCLUSIONS: Operative intervention for the treatment of adult UPJ obstruction may result in symptomatic relief and, perhaps more importantly, renal functional improvement. These findings are important for effectively counseling patients and considering indications for intervention.