Pyeloplasty for ureteropelvic junction obstruction in adults: correlation of radiographic and clinical results.

Pyeloplasty for hydronephrosis secondary to ureteropelvic junction obstruction is a proved efficacious procedure. In many cases the clinical improvement effected by technically successful pyeloplasty in children has been reported to exceed substantially radiographic improvement in caliceal appearance. To address this issue in the adult population we did a retrospective review of 52 patients who had undergone pyeloplasty for ureteropelvic junction obstruction. In 91 per cent of the patients the clinical result was satisfactory, while improvement was observed in 92 per cent of the renal units that could have been expected to benefit. The caliceal appearance on the postoperative excretory urogram was normal in only 25 per cent of the cases, showed diminution of calicectasis in 65 per cent, was unchanged in 30 per cent and deteriorated in 5 per cent. Earlier appearance of contrast medium in the upper ureter on the postoperative excretory urogram was seen in all patients who had a satisfactory clinical result. Deterioration of caliceal grade or delayed appearance of contrast medium in the ureter in the postoperative excretory urogram always was associated with a poor clinical result and/or further parenchymal loss. While a salutary effect of a technically successful operation on the clinical manifestations of hydronephrosis secondary to ureteropelvic junction obstruction is not necessarily correlated with improved or normal caliceal appearance it does correlate strongly with improvement of drainage as manifested by earlier appearance of contrast medium in the ureter. Deterioration of the caliceal grade or delayed appearance of contrast medium in the ureter implies that effective drainage is not present, which presages a poor clinical outcome and further loss of renal parenchyma.