Intermittent Hydronephrosis Secondary to Ureteropelvic Junction Obstruction: Clinical and Imaging Features

Tsai, Jeng-Daw; Huang, Fu‐Yuan; Lin, Chun-Chen; Tsai, Tsuen‐Chiuan; Lee, Hung‐Chang; Sheu, Jin‐Chuan; Chang, Pei‐Yeh

doi:10.1542/peds.2005-0583

Cited by 53 publications

(36 citation statements)

References 31 publications

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“…5 Ultrasonography is a sensitive method for the detection of dilatation of the pelvicalyceal system (PCS), but it does not differentiate between obstructive and non-obstructive dilatation. 10 The information obtained on US is only anatomical and not functional. The US can be normal in the presence of obstruction and may show dilated system in the absence of obstruction.…”

Section: Discussionmentioning

confidence: 99%

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The Accuracy of Doppler Ultrasonography in the Followup of Pyeloplasty for Congenital Pelviureteric Junction Obstruction

Bhat¹,

Joseph²,

Paul³

et al. 2017

jemds

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BACKGROUNDCongenital pelviureteric junction obstruction (PUJO) is a common condition needing surgery for the improvement of renal function. Followup after surgery requires imaging modalities involving radiation exposure. Doppler sonography is an alternative, which can avoid radiation.The aim of this study is to evaluate the accuracy of Doppler ultrasonography in the followup of patients with pelviureteric junction obstruction (PUJO) undergoing open pyeloplasty. Setting and Design-This prospective observational study was conducted in a tertiary care teaching hospital. MATERIALS AND METHODSThis study comprised of 31 patients with unilateral PUJO, who underwent open pyeloplasty. The diagnosis of PUJO was made by findings on IVU or diuretic renogram. The Renal Resistive Index was evaluated using Duplex Doppler ultrasonography. A renal RI >0.7 was considered diagnostic of obstruction. Resistive Index Ratio was calculated as the ratio of RRI of obstructed to that of opposite kidney. RIR value more than 1.11 was considered as obstruction.All patients were followed up with Doppler at 3 months after surgery and the RRI value was measured. DTPA renogram was repeated at 3 months after surgery. The data was collected and sensitivity and specificity of Doppler as a diagnostic test wa s calculated using DTPA renogram as the standard. RESULTSAmong the 31 patients, preoperative renogram showed obstruction in 19 patients and equivocal result in 12 patients. Doppler ultrasonography showed obstruction in 16 of the 19 patients with obstructive renogram. RRI of the opposite kidney showed nonobstructive value in all patients, as did the renogram. Preoperative RIR value showed obstruction in 17 out of 19 patients. Among the 12 patients with equivocal pattern who underwent pyeloplasty, preoperative RRI was suggestive of obstruction in 8 patients, while RIR showed obstruction in 9 patients. Postoperative renogram showed non-obstructive pattern in 29 patients and obstruction in 2 patients. Twenty eight out of the 29 patients with relieved obstruction had RRI < 0.70, while 1 patient showed persistently elevated RRI as well as RIR. CONCLUSIONRenogram is useful for the followup of patients who have undergone pyeloplasty and for monitoring patients with hydronephrosis under observation.

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Section: Discussionmentioning

confidence: 99%

“…The IVU can be normal in patients with intermittent obstruction. 10 Dilated PCS may be present in the absence of any obstruction, as in the case of extrarenal pelvis on IVU.…”

Section: Discussionmentioning

confidence: 99%

The Accuracy of Doppler Ultrasonography in the Followup of Pyeloplasty for Congenital Pelviureteric Junction Obstruction

Bhat¹,

Joseph²,

Paul³

et al. 2017

jemds

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“…8 Symptom-free periods are variable in duration. Other symptoms might include hematuria and/or hypertension.…”

Section: Discussionmentioning

confidence: 99%

A 7-Year-Old Girl with Periodic Flank Discomfort

Maddox¹,

Buck²,

Seguias³

2015

Pediatr Ann

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Editor's note: Each month, this department features a discussion of an unusual diagnosis. A description and images are presented, followed by the diagnosis and an explanation of how the diagnosis was determined. As always, your comments are welcome via email at pedann@Healio.com. For diagnosis, see page 101Case Challenge A 7-year-old girl with a 12-month history of intermittent left flank pain was transferred to our institution from an outside hospital. Severe pain occurred about once per month and was associated with multiple episodes of nonbloody, nonbilious emesis. The pain did not radiate and was not alleviated or exacerbated by anything else. Symptoms lasted 2 to 3 days and then gradually resolved. The patient denied associated dysuria, hematuria, fever, or diarrhea. The patient had visited her pediatrician's office several times, but diagnostic work-ups for urinary tract infection and constipation were negative. A recent renal ultrasound revealed severe left hydronephrosis. Due to recurrent pain, the patient was seen at an outside hospital, where a computed tomography (CT) scan was ordered (Figure 1).Her most current painful episode started 5 days prior to admission. Initial physical examination revealed a well-developed and well-nourished child with normal vital signs, including normal blood pressure. Her anthropometric parameters were within normal limits for age. HEENT (head, eyes, ears, nose, and throat) examination, respiratory examination, and cardiovascular examination were all unremarkable. On abdominal examination there was left costo-vertebral angle tenderness but no palpable mass. Her neurologic assessment was normal. No rashes or skin lesions were present.

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“…In our case PUV was ruled out by the presence of a normal MCUG and absence of bladder trabeculation and hypertrophy which are typically seen in a valve bladder [2].Transient VUR due to retention of urine could be missed by a delayed MCUG and hence its possibility cannot be ruled out completely. Intermittent ureteropelvic junction obstruction can also present as transient, recurrent hydronephrosis with a characteristic sonographic finding of a thickened pelvic wall seen during recovery [3]. The diagnosis can be missed during a pain free episode.…”

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confidence: 99%

Reversible, Unilateral Dilatation of Upper Urinary Tract due to a Tight Waist String

et al. 2011

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Intermittent Hydronephrosis Secondary to Ureteropelvic Junction Obstruction: Clinical and Imaging Features

Abstract: The keys to diagnosis are awareness of the syndrome, a detailed history, and immediate and serial imaging studies during painful crises. A thickened renal pelvic wall during convalescence is an important ultrasonic sign of intermittent hydronephrosis.

Cited by 53 publications

References 31 publications

The Accuracy of Doppler Ultrasonography in the Followup of Pyeloplasty for Congenital Pelviureteric Junction Obstruction

The Accuracy of Doppler Ultrasonography in the Followup of Pyeloplasty for Congenital Pelviureteric Junction Obstruction

A 7-Year-Old Girl with Periodic Flank Discomfort

Reversible, Unilateral Dilatation of Upper Urinary Tract due to a Tight Waist String

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