A 24-year-old man has episodic left loin pain that characteristically worsens after social drinking of beer. Ultrasound shows grade 3 hydronephrosis with no visible stone. A diuretic (frusemide) renogram shows preserved differential function of 46 percent on the left and an excretory half-time of 28 minutes after diuresis. What is the most appropriate management?

• A Anderson-Hynes dismembered pyeloplasty ✓
• B Left nephrectomy
• C Disopyramide-assisted watchful waiting with annual ultrasound
• D Insertion of an indwelling JJ ureteric stent for six months

Explanation

The classic history of pain precipitated by fluid and alcohol loads, dilatation without calculus, and a diuretic renographic excretory half-time longer than 20 minutes establishes obstructive pelviureteric junction obstruction with significant but recoverable function. Dismembered pyeloplasty relieves the obstruction and preserves the 46 percent function; nephrectomy is reserved for function below roughly 15 to 20 percent. C JJ stent does not treat the intrinsic narrowing and long-term stenting invites infection.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.