Ureteropelvic junction obstructions: is side a prognostic factor?

Abstract

Background: Ureteropelvic junction obstructions (UPJOs) occur more frequently on the left than on the right side. Among patients diagnosed during the neonatal period, those with left‑side UPJO have a more severe course than those with right‑side UPJO. Aim: This study examined clinical advances in the surgical management of right and left symptomatic UPJOs preoperatively and postoperatively, based on a retrospective analysis of cases. Patients and Methods: In this retrospective clinical trial, 650 patients were evaluated at the time of diagnosis and at surgery. Results: Left‑side UPJO was diagnosed in 66.1% of patients (P = 0.017). The median age of the patients at surgery for left‑ and right‑side UPJO was 1.5 and 4.2 years, respectively (P = 0.001). At the preoperative evaluation, the ratio of parenchymal thickness (RPT) on the UPJO side versus the contralateral side was 0.55 ± 0.3 and 0.7 ± 0.3 for patients with left‑side and right‑side UPJO, respectively (P = 0.029). RPT during the first postoperative year was 0.83 ± 0.2 for patients treated on the left side and 0.9 ± 0.3 for those treated on the right side (P = 0.25). The respective values at 3 years postoperatively were 0.8 ± 0.3 and 0.9 ± 0.2 (P = 0.09). The preoperative kidney function value in the left‑side group was 42.5 ± 13.4, which declined to 39.52 ± 15.8 at the 3‑year follow‑up examination. In the right‑side group, preoperative kidney function was 38.8 ± 16.1, which increased to 40.2 ± 13.2 at 3 years postoperatively. Both the decline and improvement were significant (both P = 0.006). Conclusions: Those with left‑side UPJO had a more severe course than those with right‑side UPJO.