PURPOSE: A ureteropelvic junction (UPJ) obstruction is a congenital anomaly commonly afflicting the pediatric population. However, it is also more frequent than generally appreciated in the adult population. This study was performed to understand the specific characteristics of the clinical presentations, courses and surgical success rate for 30 adults, who required surgery for a UPJ obstruction. MATERIALS AND METHODS: The medical records of 30 adults (16men, 14women, 18 to 65years old, with a median age of 34years) with a urographically proven, clinically significant, UPJ obstruction, who underwent 30 pyeloplasties between 1993 and 1999 were retrospectively reviewed. All patients were followed up for at least 3 months. An excretory urogram and 99mTc-DTPA renal scan were performed for the majority of patients, pre-operatively and 3 months post-operatively. RESULTS: The majority of the patients presented with flank pain (83.3%). The diagnosis was frequently delayed with an average duration of symptoms of 22 months. In the excretory urography, 81.5% was predominantly involved in the extrarenal pelvis. Thirteen of the 30 patients had associated urinary abnormalities (6; renal calculi, 2; duplicating system, 2; previous pyelonephritis, 1; horseshoe kidney, 1; ureterovesical junction obstruction). The majority of patients underwent a dismembered pyeloplasty (60.0%). The major cause of the UPJ obstructions was an intrinsic stenosis (53.3%). The success rate depending on the radiological finding was 93.3%. CONCLUSIONS: The results suggest that a UPJ obstruction in adult has a low bilaterality, a low incidence of vesicoureteral reflux, a high association with a renal stone when compared to children. Although the diagnosis was delayed with an average duration of 22 months since the onset of symptoms, the overall surgical success rate depending on radiologic finding was similar to that for children. The extrarenal pelvis may be one of the influencing factors to a high surgical success rate.
Adult* ; Child ; Constriction, Pathologic ; Diagnosis ; Flank Pain ; Humans ; Incidence ; Kidney ; Kidney Calculi ; Medical Records ; Pelvis ; Pyelonephritis ; Retrospective Studies ; Ureter ; Urography ; Vesico-Ureteral Reflux

PURPOSE: Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease. MATERIALS AND METHODS: This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom's criteria at 1, 3, 6, 12, and 24 months after treatment. RESULTS: The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom's criteria after PEN were also not different according to dural sac cross-sectional area by disc material. CONCLUSION: PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.
Adult ; Aged ; Back Pain/etiology/*surgery ; Dura Mater/*pathology ; Female ; Humans ; Intervertebral Disc ; Intervertebral Disc Displacement ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Spinal Stenosis/complications/*pathology ; Tissue Adhesions/*surgery ; Treatment Outcome ; Visual Analog Scale