Shortcomings of diuresis scintigraphy in evaluating urinary obstruction: comparison with pressure flow studies

Dacher, Jean‐Nicolas; Pfister, Christian; D, Thoumas; Véra, Pierre; Liard-Zmuda, A.; Chomant, J; Mitrofanoff, P; Dosseur, P. Le

doi:10.1007/s002470050687

Cited by 20 publications

(9 citation statements)

References 12 publications

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“…This finding has been reported previously in an anecdotal manner [29]. The difference between the post-surgical population and the control population was found to be statistically significant in this regard.…”

Section: Discussionsupporting

confidence: 83%

Diuretic renogram clearance half-times in the diagnosis of obstructive uropathy: effect of age and previous surgery

Karam

Feustel

et al. 2003

Nuclear Medicine Communications

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Diuretic renography with radiotracers has been used successfully to diagnose obstruction in patients with hydronephrosis. Controversy persists with regard to the best approach for the interpretation of renogram curves: visual analysis or a quantitative index, i.e. the clearance half-time. The latter is often reported to be in the intermediate or non-diagnostic range. It is important to measure the incidence of equivocal half-times in various subsets of patients with hydronephrosis in order to determine in which settings the measurement of this index may be clinically useful. We performed a retrospective study of diuretic renograms performed at our institution between 1997 and 2000 for the evaluation of suspected uretero-pelvic junction (UPJ) obstruction. Vigorous intravenous hydration, exceeding current guidelines, was employed in these patients. Three hundred and seventy-seven renogram curves in 205 patients were analysed. Patients were divided into three groups: >1 year of age; 20 min) or intermediate (half-time, 10-20 min). In patients >1 year of age, 37% of 101 renograms showed normal half-times before furosemide, 20% showed normal half-times after furosemide, 44% showed prolonged half-times and none (0%) showed an intermediate half-time. In patients 1 year. Caution is advised when interpreting this finding in this age group. The measurement of washout was less useful in patients who had undergone a corrective procedure, because of the high rate of 'indeterminate' and 'abnormal' values in spite of successful surgery. Vigorous intravenous hydration, exceeding...

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Section: Discussionsupporting

confidence: 83%

Diuretic renogram clearance half-times in the diagnosis of obstructive uropathy: effect of age and previous surgery

Karam

Feustel

et al. 2003

Nuclear Medicine Communications

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“…Wolf et al [6] showed in 1996 that in adults, urography and diuretic scintigraphy are sufficient in the standard diagnostic work up for urinary tract obstruction; the APM is again mentioned to be ‘additional’. A study similar to the one undertaken by Whitaker in 1984 was conducted in 1999 in 34 children by Dacher et al [7]. This study demonstrated that pressure-flow tests can be considered in children with equivocal outcomes of their (99 m)-Tc-DTPA furosemide diuresis renography.…”

Section: Discussionmentioning

confidence: 77%

Antegrade pressure measurement as a diagnostic tool in modern pediatric urology

Veenboer

Jong

2011

World J Urol

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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.

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“…Traditionally, antegrade pressure measurements (APMs) of the renal pelvis and the upper ureter are recorded by percutaneous access to the kidney or by the perfusion pressureow test (Whitaker test) [3][4][5], which risk invasive renal bleeding and urinary tract infection. Other methods, such as radionuclide renogram, Doppler vessel resistance and intravenous urography [6][7][8][9], lack sensitivity and speci city. A quantitative, non-invasive and e ective method is needed.…”

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confidence: 99%

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

Cai

Li²,

Zhu³

et al. 2012

CIM

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A practical pressure measuring method for the upper urinary tract during ureteroscopy AbstractPurpose: e purpose of this study was to develop and test a method for measuring pressure in the upper urinary tract during ureteroscopic operations and to evaluate its e cacy and clinical signi cance.Methods: A total of 44 patients, each with a ureteral calculus in the proximal ureteral segment, were enrolled in the study group: 21 patients with an acute and 23 with a chronic obstruction. e ureteroscope was passed forward to the upper segment of the obstructed ureter immediately a er the calculus was broken and the intraluminal ureteral pressure was then transmitted along with the irrigant ow (0.9% sodium chloride).Results: e mean ureteral pressures of the acute obstruction subgroup, the chronic obstruction subgroup and the control group were 74.5 mmHg (22-180 mmHg), 32.5 mmHg (9-53 mmHg) and 10.2 mmHg (8-13 mmHg), respectively. A signi cant correlation was found between ureteral pressure and the following indexes: the duration of the obstruction (r=0.985), the diameter of the ureter above the calculus (r=0.878) and the depth of the hydronephrosis of the renal pelvis (r=0.862). No associations were observed between the pressure and the serum creatinine level (r=0.214) or the urinary leukocyte count (r=0.047). e intraluminal pressure correlated with the glomerular ow rate (GFR) of the a ected kidney (r =0.975, P =0.001).Conclusions: is new method is non-invasive, practical and reproducible. Measuring the intraluminal pressure of the ureter can provide a valuable index to quantify the severity of the obstruction of the upper urinary tract, which is helpful for the prediction of the affected renal function prognosis. [3][4][5], which risk invasive renal bleeding and urinary tract infection. Other methods, such as radionuclide renogram, Doppler vessel resistance and intravenous urography [6][7][8][9], lack sensitivity and speci city. A quantitative, non-invasive and e ective method is needed.Recently, ureteroscopy has become a common minimally invasive examination method in the treatment of ureteral calculi [10]. During ureteroscopy, the ureteroscope presses closely to the ureteral wall, and the intraluminal pressure of the ureter can be transmitted along with the owing of the irrigation uid. A er the ureteral calculi are fragmented, the ureteroscope passes the calculus, and the pressure of the ureter is measured by connecting the ureteroscope to a sensitive digital pressure monitor. In this study, we aimed to investigate the feasibility and e cacy of this method in patients with varying severities of calculus obstruction. Materials and Methods Clinical DataFrom July 2010 to July 2011, 44 consecutive patients, including 24 men and 20 women with an average age of 40.2 years (range 18-63 years), were enrolled in the study group. e inclusion criteria were ureteral obstruction caused by ureteral stones, accompanied by hydronephrosis or pyonephrosis. e exclusion criteria were severe de ciency of blood coagulation function and s...

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Shortcomings of diuresis scintigraphy in evaluating urinary obstruction: comparison with pressure flow studies

Cited by 20 publications

References 12 publications

Diuretic renogram clearance half-times in the diagnosis of obstructive uropathy: effect of age and previous surgery

Diuretic renogram clearance half-times in the diagnosis of obstructive uropathy: effect of age and previous surgery

Antegrade pressure measurement as a diagnostic tool in modern pediatric urology

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

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