Cineurethrography and Voiding Cinecystography, With Special Attention to Vesico-Ureteral Reflux

Gross, Kenneth E.; Sanderson, Stevens S.

doi:10.1148/77.4.573

Cited by 33 publications

(3 citation statements)

References 6 publications

(9 reference statements)

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The purpose of this paper is to consider the pelvi-ureteric obstruction which is occasionally seen in association with vesico-ureteric reflux in the light of recent and more critical reappraisal of hydronephrosis (Whitaker, 1975(Whitaker, , 1976.With the advent of image intensification and good quality micturition cystourethrography it was soon recognised that a marked degree of reflux could result in an appearance of the renal pelvis suggestive of pelvi-ureteric obstruction (Gross and Sanderson, 1961 ; Hutch, Hinman and Miller, 1962). In these early descriptions it was not stated how long the pelvis remained full after voiding was completed so that no real evidence of an obstruction was presented.

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“…In these early descriptions it was not stated how long the pelvis remained full after voiding was completed so that no real evidence of an obstruction was presented. However, Hutch et al (1962) did suggest that in the presence of a closed type of renal pelvis (Hanley, 1959) reflux could induce a hydronephrosis which remains, and perhaps even becomes symptomatic, long after the reflux has spontaneously stopped.Shopfner (1966) made the important observation, sadly all too often forgotten, that not all dilated renal pelves, with or without reflux, are obstructed. But he agreed that reflux, perhaps with infection, could play a major role in the pathogenesis of pelvi-ureteric obstruction.…”

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confidence: 99%

“…With the advent of image intensification and good quality micturition cystourethrography it was soon recognised that a marked degree of reflux could result in an appearance of the renal pelvis suggestive of pelvi-ureteric obstruction (Gross and Sanderson, 1961 ; Hutch, Hinman and Miller, 1962). In these early descriptions it was not stated how long the pelvis remained full after voiding was completed so that no real evidence of an obstruction was presented.…”

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Reflux Induced Pelvi-ureteric Obstruction

Whitaker

1976

British Journal of Urology

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The phenomenon of pelvi-ureteric obstruction which is induced by vesico-ureteric reflux is well documented but ill understood. The radiographic findings can be impressive to an extent that obstruction is probably often over-diagnosed. Before considering a pyeloplasty it is essential to confirm the true obstructive nature of the problem. Where the urogram is not suggestive of an obstruction a re-implantation of the ureter will usually stop the gross pelvic dilatation. It is suggested that the obstruction is at least partially an active process.

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Reflux Induced Pelvi-ureteric Obstruction

Whitaker

1976

British Journal of Urology

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Renal Biopsy in Recurrent Urinary Tract Infection

Williams¹,

Fowler²

1963

Am J Dis Child

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There are still many gaps in our understanding of the natural history of pyelonephritis and its relation to recurrent urinary tract infection. Increasing attention is turning, therefore, to the problem of urinary tract infection in childhood, with its possible implications for chronic renal and vascular disease in early adult life. Unfortunately, however, neither clinical features, urine analysis, nor radiographic findings are always sufficient to establish the diagnosis of pyelonephritis beyond question.Recent studies by colony counting techniques 1,2 have done much to emphasize the potential seriousness of bacteriuria unaccompanied by pyuria and to distinguish between significant bacteriuria and mere bacterial contamination of the urine. However, neither colony counting techniques 1,2 nor the newer provocative pyrogen test3,4 can distinguish between infections located in the kidney and those arising elsewhere in the urinary tract, so that direct evidence obtained by renal biopsy should contribute to our overall picture of the urinary infection problem. Information so far is meager concerning the early pathogenesis of pyelonephritis in man as well as the renal biopsy findings in urinary tract infections in childhood.Although it is one of the oldest urological axioms that urinary stasis predisposes to infection, in most reported studies of pye¬ lonephritis in adult patients a thorough radiographic and urological assessment of any accompanying anatomical or physiological abnormalities of the urinary tract is seldom reported in detail. Gross anatomical abnor¬ malities causing obvious mechanical obstruc¬ tion have long been recognized and are usually evidenced by clinical features and by intravenous pyelography. Such routine screening methods, however, will often miss functional abnormalities responsible for uri¬ nary stasis 5·6 or congenital dilatations not caused by obstruction to urine flow.7"9 The

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