Conservative management of pelvi-ureteric junction obstruction (PUJO): is it appropriate and if so what duration of follow-up is needed?

Objective: To establish whether it is safe to manage minimally symptomatic and asymptomatic pelvi-ureteric junction obstruction (PUJO) conservatively. Patients and Methods: In all, 50 patients with PUJO diagnosed with dynamic renography, and monitored with at least two renograms. Results: In all, 19 patients were totally asymptomatic, while 31 patients had minimal symptoms at time of diagnosis. The mean follow-up was 53 months. During the course of follow-up 10 of the 50 patients deteriorated. All patients who had asymptomatic renographic deterioration, deteriorated within 2 years of diagnosis. Eight of the 10 patients that deteriorated needed pyeloplasty and two nephrectomy. Conclusions: Conservative management of patients with minimally symptomatic and asymptomatic PUJO is safe. Discharging patients could be considered at 2 years from diagnosis, if they remain renographically stable and asymptomatic or minimally symptomatic.