DIFFERENCES IN OUTCOMES OF PELVI-URETERIC JUNCTION OBSTRUCTION AMONG PATIENTS DETECTED INCIDENTALLY VERSUS THOSE PRESENTING SYMPTOMATICALLY: A RETROSPECTIVE STUDY

Abstract

Background: Pelvi-ureteric junction (PUJ) obstruction often leads to progressive renal functional loss. As many cases are now detected incidentally on imaging performed for unrelated indications, it remains unclear whether early surgical intervention in these patients improves long-term outcomes compared with those who present with symptoms. Methods: In this Retrospective study, records of 41 adults who had undergone pyeloplasty for confirmed PUJ obstruction (13 detected incidentally, 28 detected symptomatically) were reviewed, with six months of postoperative data assessed using ultrasound, diuretic renography, Visual Analogue Scale (VAS) pain scores, and the 36-item Short Form (SF-36) quality-of-life instrument. Pre-operative, intra-operative, and 6-month outcomes were reviewed and compared between groups. Results: Symptomatic patients had significantly worse baseline parameters than incidentally diagnosed patients, including a greater antero-posterior diameter (APD) of the renal pelvis (45.1 vs 28.4 mm), lower differential renal function (DRF; 33.6% vs 42.1%), and longer T½ on renography (58.3 vs 34.6 minutes; all p<0.001). Radiological success at six months was comparable between groups (92.3% vs 78.6%; p=0.25). However, symptomatic patients required longer operative time, experienced greater blood loss, and had a longer hospital stay. Conclusions: Incidentally detected PUJ obstruction is associated with better baseline renal function and excellent outcomes after early pyeloplasty. These findings support early surgical intervention in incidentally detected cases, before symptoms and functional deterioration develop, to preserve renal function.