A 30-year-old man reports episodes of severe left loin pain occurring after drinking several glasses of beer. Ultrasound shows left hydronephrosis with normal calibre ureter, and diuretic renography confirms impaired drainage from a left pelviureteric junction obstruction. What is the standard operative procedure for this condition?

• A Ureteroscopic endopyelotomy
• B Ileal ureter replacement
• C Extracorporeal shock wave lithotripsy
• D Anderson-Hynes dismembered pyeloplasty ✓

Explanation

Symptomatic pelviureteric junction obstruction with impaired drainage on renography is treated by Anderson-Hynes dismembered pyeloplasty, which excises the obstructing segment and creates a dependent, funnel-shaped anastomosis, giving durable success rates around 90 percent. Beer provokes symptoms because alcohol-induced diuresis overwhelms the narrowed junction, the classic Dietl crisis. Endopyelotomy gives lower success rates and ileal substitution is reserved for extensive ureteric loss.

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.