Comparison Between Diuretic Urography (IVP) and Diuretic Renography for Diagnosis of Ureteropelvic Junction Obstruction in Children

Abstract

Background:Ureteropelvic junction obstruction (UPJO) is one of the most common causes of urinary tract obstruction in children. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography (US), intravenous pyelogram (IVP), diuretic renography (DR), magnetic resonance urography (MRU) and antegrade or retrograde pyelography. Nowadays it is suggested to use diuretic renography as the best method for diagnosing of UPJO. There is no comparative study between IVP and DR scan for diagnosis of UPJO in children.Objectives:The aim of the present study was to compare IVP with furosemide injection and diuretic renography in diagnosis of clinically significant UPJO.Patients and Methods:This was a cross sectional study performed in 153 UPJO suspected children (121 boys, 32 girls) based on US findings in cases presented with urinary tract infection (UTI), prenatal hydronephrosis, abdominal/flank pain, abdominal mass and hematuria. Renal ultrasound was used as an initial screening tool for detection of urinary tract abnormality. Vesicoureteral reflux (VUR) was ruled out by voiding cystourethrography (VCUG). Serum creatinin, blood urea nitrogen, urinalysis and urine culture was screened in all cases. IVP with furosemide and DR were performed as soon as possible after the mentioned workup.Results:During a five year period, 46 out of 153 patients were diagnosed as UPJO based on diuretic renography: the age ranged from 4 months to 13 years (mean: 3.1 ± 0.78 years). There was a significant higher (76%) proportion of UPJO in the boys and in the left side (78%). The sensitivity of IVP with furosemide injection in diagnosis of UPJO was 91.3% whereas DR was accepted as standard for diagnostic procedure in diagnosis of UPJO.Conclusions:Although DR is accepted as the best method for diagnosis of UPJO, we found a small sensitivity difference between IVP and DR in kidneys with normal or near normal function. In many settings such as small cities lacking facilities for advanced isotope imaging technology, use of IVP with diuretic maybe an acceptable procedure for diagnosis of UPJO.

Experience Summary of Laparoscopic Treatment for Pediatric Ureteral Polyps

“…Considering a repeated resection of the diseased segment may be a challenge to the anastomosis, and referring to the method of ureteroscopic treatment for polyps, the second polyp was only treated by the complete resection of polyp to retain the diseased segmental ureter (11). If the diseased segmental ureter is too long, it may lead to excessive tension between the anastomosis and the ureter, resulting in repeated anastomotic obstruction or ureteral necrosis at the anastomotic stoma.…”

Urinary Ultrasound and Other Imaging for Ureteropelvic Junction Type Hydronephrosis (UPJHN)

“…Although IVP indications have decreased with advances in imaging technology, it is still used in some centers where advanced imaging methods are limited. Dilatation of collecting system, with parenchymal changes in the nephrogram phase, and delay in excretion of contrast medium are characteristic findings of obstructive hydronephrosis (71). But IVP is not sufficient for visualization of poorly functioning kidneys which are severely blocked due to poor contrast excretion (72).…”

The Rating System of Urodynamics Upper Urinary Tract in Children under Three Years Old with Congenital Hydronephrosis

“…Кузовлева 2 , К.М. Матюшина 2 ных методов с/без проведения пробы с фуросемидом: динамическая ренография [8] и пиелоэхография [9], диуретическая экскреторная урография [10], функциональная магнитно-резонансная томография [11].…”