A 22-year-old woman with recurrent left loin pain undergoes a diuretic MAG3 renogram. The affected kidney contributes 32% of total split renal function with a T half time of 25 minutes after furosemide. What is the most appropriate management?

• A Continue observation with serial renography
• B Antegrade balloon dilation of the pelviureteric junction
• C Nephrectomy
• D Anderson-Hynes dismembered pyeloplasty ✓

Explanation

Symptomatic pelviureteric junction obstruction with deteriorating function, here split function below 40% with delayed washout (T half time above 20 minutes), is an indication for surgical correction. The Anderson-Hynes dismembered pyeloplasty remains the standard operation with success rates above 90%. Observation is reserved for asymptomatic mild obstruction with preserved function. Nephrectomy needs function generally below 15 to 20%. Balloon dilation gives inferior durable results in intrinsic strictures.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.