The validity of ultrasound in the diagnosis of pyonephrosis in infants and children was retrospectively investigated in 14 patients. The disease was unilateral in 13 patients and bilateral in one. The diagnosis was proven by percutaneous nephrostomy in 7 and by operation in 7 patients. Ultrasound was true positive in 9 patients (10 kidneys) and false negative in 5. Large staghorn calculi were present in 2 of the 5 false negative cases. A group of 20 patients with simple hydronephrosis, investigated by percutaneous punctures, served as a control group. There were two false positive cases in this group. The sensitivity of sonography for the diagnosis of pyonephrosis was only 66.7%, which is considerably lower than in previous reports. We therefore recommend early sonographically guided percutaneous puncture of the renal pelvis whenever pyonephrosis is suspected.

A diagnostic schedule in pyonephrosis was followed in thirteen infants and children. Obstruction of the urinary tract could be demonstrated in 12 patients, non-obstructive pyonephrosis was present in one case. Congenital obstructive malformation of the urinary tract was found in 7 patients, obstruction was acquired in 5. Sonographically, pyonephrosis could be diagnosed in 8 patients (64.3%). Excretory urography (10/13) was helpful in no actual case. Sonographical-guided percutaneous nephrostomies were performed in 5 patients and operative nephrostomies in 4. Emergency-nephrectomies were done in 4 patients. A tap of the renal pelvis is the best way for early diagnosis whenever pyonephrosis is clinically suspected.

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In a sample of 18 children aging one day to eighteen years 21 percutaneous nephrostomies and 27 antegrade pyelographies were performed using sonography and fluoroscopy. Thirteen patients had both nephrostomy and pyelography and 5 had only pyelography. Three of 13 patients needed bilateral nephrostomies. The results indicate that the combination of percutaneous nephrostomy and antegrade pyelography is helpful in diagnosis and treatment of various obstructive disorders of the urinary tract especially in the newborn period.