Ureteropelvic Junction Obstruction · Observe vs Pyeloplasty

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Symptoms/function/progression
   Symptoms? Split renal function? Hydronephrosis progressing? Infection?
   • Symptomatic (pain/infection/stone) or split function <40%/declining or progressive hydronephrosis → Symptomatic/declining function → pyeloplasty
   • Asymptomatic, good split function, stable → Asymptomatic good → observe
   • With infection/pyonephrosis/acute obstruction → Infection/pyonephrosis → emergency drainage
2. [End] Asymptomatic good → observe
   Asymptomatic, preserved split function, stable hydronephrosis → observe: serial ultrasound + diuretic renography follow-up; surgery if it worsens (symptoms/declining function).
3. [End] Symptomatic/declining function → pyeloplasty
   Symptomatic/split function <40% or declining/progressive hydronephrosis → dismembered pyeloplasty (Anderson-Hynes; open/laparoscopic/robotic); selective endopyelotomy (short segment, no crossing vessel).
4. [End] Infection/pyonephrosis → emergency drainage
   With infection/pyonephrosis/acute obstruction → emergency drainage (percutaneous nephrostomy or ureteric stent) + antimicrobials, with pyeloplasty once stable.

Source guidelines & references

• Ureteropelvic junction obstruction (UPJO) management (AUA/EAU; dismembered pyeloplasty)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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