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Surgical intervention and long-term renal outcomes of congenital ureteropelvic junction obstruction in a young adult cohort

  • Urology – Original Paper
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Abstract

Purpose

To evaluate the impact of surgical intervention on long-term renal outcomes for adult patients with congenital ureteropelvic junction obstruction (UPJO).

Methods

We queried service members diagnosed with UPJO from the United States Military Health System electronic health records from 2005 to 2020. We assessed demographic, laboratory, radiology, surgical intervention, and outcome data. We evaluated the impact of surgical intervention on renal function based on the estimated glomerular filtration rate (eGFR), hypertension (HTN, defined as any prescription for blood pressure [BP] medication and/or average of two BP readings ≥ 130/80 mmHg more than 2 weeks apart), and changes in renal excretory function on radionuclide scans.

Results

We identified 108 individuals diagnosed with congenital UPJO; mean follow-up of 7 years. Mean age at diagnosis was 25 years; 95% male; 69% White, 15% Black. At diagnosis, median BP was 130/78 mmHg and mean eGFR 93 ml/min/1.73m2. Subsequently, 85% had pyeloplasty and 23% had stent placement. There were no significant differences in mean eGFR pre- and post-intervention (94 vs. 93 ml/min/1.73m2, respectively; p = 0.15) and prevalence of defined HTN (59% vs. 61%, respectively; p = 0.20). Surgical intervention for right-sided UPJO significantly reduced the proportion of patients with delayed cortical excretion (54% pre vs. 35% post, p = 0.01) and T½ emptying time (35 min vs. 19 min, p = 0.009). Similar trends occurred with left-sided UPJO but were not significant.

Conclusion

Surgical intervention was not associated with significant differences in the long-term outcomes of kidney function and HTN prevalence in our young adult cohort. However, renal excretory function improved on radionuclide scans.

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Data availability

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Acknowledgements

We would like to acknowledge Sarah Khan, MD, Erin Parker, MD, and John Thurlow, MD for their contributions to this study. We also appreciate the advice from our urology colleagues, Thomas Gerald, MD and Brock Boehm, MD.

Funding

The authors did not receive any funding for this study.

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Authors and Affiliations

  1. Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Alexandra R. Stewart, Stephen W. Olson, Maura A. Watson, Christina M. Yuan & Robert Nee

  2. Department of Medicine, Uniformed Services University, Bethesda, MD, USA

    Alexandra R. Stewart, Maura A. Watson, Christina M. Yuan & Robert Nee

  3. Pediatric Nephrology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Brent L. Lechner

Authors
  1. Alexandra R. Stewart
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  2. Stephen W. Olson
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  4. Maura A. Watson
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  5. Christina M. Yuan
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  6. Robert Nee
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Contributions

Conceptualization: ARS, SWO, RN; Methodology: ARS, SWO, BLL, MAW, CMY, RN; Formal analysis and investigation: ARS, SWO, RN; Writing-original draft preparation: ARS, RN; Writing-review and editing: ARS, SWO, BLL, MAW, CMY, RN; Supervision: RN.

Corresponding author

Correspondence to Robert Nee.

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The authors have no competing financial or non-financial interests related to this study.

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Disclaimer: The views expressed in this manuscript are those of the authors and do not necessarily reflect the official policy of the Department of Defense or the U.S. Government. Stephen W. Olson, MD is currently an employee of Novartis Pharmaceuticals.

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Stewart, A.R., Olson, S.W., Lechner, B.L. et al. Surgical intervention and long-term renal outcomes of congenital ureteropelvic junction obstruction in a young adult cohort. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04075-9

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