In this section, I find a recurring problem identifying variables predictive of surgery in patients with UPJO (ureteropelvic junction obstruction): they tend to be those that the specific surgeon chose. For example, if the surgeon operates on all UPJO in children with red hair, the study will find that red hair is predictive of the need for surgery.
Contrast that with what Dr. Koff did many years ago…..
And talking about Dr. Koff, there was an abstract from the Columbus Ohio group regarding pyeloplasty in patients with poor function. They had 3 patients with less than 10% function and 9 with 10-20% function. Both of these groups saw a mean post pyeloplasty improvement in function of 4-5%.
In the past, I had tried a nephrostomy tube for a month to decide on whether to do nephrectomy or pyeloplasty. Based on this abstract I will consider just doing a pyeloplasty in patients with at least some function (>5%?). It had never felt right to me to remove kidneys with 14% function. Of course 4-5% gain in function might not be worth the risk of surgery so I would only do that when I think the risk of future infection (severe hydronephrosis) might be significant.