Idiopathic Hydronephrosis (Pelviureteric Junction Obstruction)

Abstract

Idiopathic hydronephrosis [syn. pelviureteric junction (PUJ) obstruction] is an important cause of obstructive uropathy (Fig. 7.1). While not as common as some other conditions such as stone disease, reported series from various centres in the last few years nonetheless contain large numbers of patients (Table 7.1), and most urologists will see several new cases each year. The condition may present at any age. It demonstrates most of the general problems encountered in urinary obstruction and many individual ones peculiar to the condition. The necessity for its accurate assessment is emphasised by the fact that many cases showing apparent obstruction at the PUJ are not obstructed and do not require intervention (Fig. 7.2) (O’Reilly et al. 1978, 1979a, 1981; Koff et al. 1979, 1980; O’Reilly and Gosling 1982). In others, the kidney will be lost without surgical correction. Any management decisions taken without accurate preoperative investigation will be at best unwise, probably inappropriate and, at worst, dangerous. {tly|111-1}