Antegrade pressure measurement as a diagnostic tool in modern pediatric urology

Abstract

IntroductionThe antegrade pressure measurement (APM) or perfusion pressure-flow test (Whitaker test) is a method of antegrade measurement of pressure in the upper urinary tract. In this study, we present the long-term follow-up results of APMs performed in our institution in the late 1980s and early 1990s to see whether the diagnostic decisions that were based on the outcomes of the test prove to be correct in the long term.Materials and methodsWe conducted a retrospective study by searching our hospital’s electronic database. We found a total of 16 APMs performed between 1987 and 1995 (10 boys, six girls; mean age 61 months).ResultsIn nine cases, action was undertaken immediately after the APM had been performed; in seven cases, this was a surgical procedure (re-implantation/re-calibration or pyeloplasty) after obstruction was demonstrated. In two cases (both postoperative after previous pyeloplasty), absence of obstruction was demonstrated and nephrostomy tubes were subsequently closed. In one case, this resulted in hydronephrosis that had to be treated with a new JJ stent. In all the seven cases in which no action was deemed necessary as a result of the outcome of the APM, long-term follow-up showed that intervention had indeed not been necessary.ConclusionAlthough not often used anymore, the APM seems to be a safe and valuable diagnostic tool in the work up for possible urinary tract obstruction in children, especially in cases in which there is serious doubt concerning conservative watchful waiting.

A practical pressure measuring method for the upper urinary tract during ureteroscopy

“…ese pressure values have been previously shown to depend on the severity and duration of the obstruction [16][17]. A signi cant correlation between the pressure and the GFR was found in this study.…”

Functional Multiparametric Magnetic Resonance Imaging of the Kidneys Using Blood Oxygen Level Dependent and Diffusion-Weighted Sequences

“…Renal diuretic scintigraphy and antegrade perfusion pressure-flow test (Whitaker test) 2 are the current gold standards to diagnose and monitor UUT obstruction. However, both methods have relevant drawbacks limiting their value in daily practice.…”

“…Furthermore, it is time-consuming, exposes patients to radiation and provides no information on renal morphology. The Whitaker test is invasive and may overestimate obstructive phenomena leading to a false positive diagnosis of obstruction in cases of reduced renal function 2,4 . Alternatively, excretory urography or contrast-enhanced CT may provide some information, but the need for intravenous contrast medium administration, exposure to ionizing radiation and the risk of fornix rupture have limited their use.…”

Antegrade pressure measurement of urinary tract in children with persistent hydronephrosis

“…The study of the ureteral opening pressure (by constant flow or pressure) has a high positive predictive value when above 14 cm H2O (8). Otherwise, Veenboer and Jong showed a high negative predictive value (12). In the present study, all patients treated clinically had no progression of the obstruction (asymptomatic and without renal damage) in a follow-up that varied from 2 to 12 years.…”

“…The antegrate pressure measurement of the upper urinary tract (APM), although invasive, is an important diagnostic tool for the decision-making of forms of treatment of children with persistent post-surgical hydronephrosis (12). This method is widely used in adults, but rarely in children.…”