A 22-year-old woman has recurrent dull right flank pain relieved partly by lying down. CT urography shows a right pelviureteric junction obstruction with a normal calibre distal ureter. Diuretic renography shows split renal function of 55% on the right with a half-time of clearance of 35 minutes after frusemide. What is the correct management?

• A Observation with annual renography
• B Anderson-Hynes dismembered pyeloplasty ✓
• C Percutaneous nephrostomy as definitive treatment
• D Right simple nephrectomy

Explanation

Symptomatic pelviureteric junction obstruction with an obstructed diuretic renogram (half-time greater than 20 minutes) warrants surgical correction even when split function is preserved. The gold standard operation is the Anderson-Hynes dismembered pyeloplasty, which excises the dysfunctional segment and creates a dependent, funnel-shaped anastomosis. Nephrectomy is reserved for function below roughly 15 to 20%, and observation is inappropriate once symptoms and objective obstruction coexist.

Reference: Smith and Tanagho's General Urology, 19th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.