Idiopathic Hydronephrosis (Pelviureteric Junction Obstruction)

Is Retrograde Ureterography Indicated in Pelviureteric Junction Obstruction?

“…Perfusion flow studies (Whitaker test) have been accepted by most workers as the gold standard for diagnosis of PUJ obstruction (Whitaker, 1979;Hay et al, 1984) and in the rare instance of non-invasive tests not confirming the clinical suspicion this procedure may be indicated. The need to visualise the ureter fully on the effected side as part of the screening for idiopathic obstruction is frequently reported (Anderson, 1963 ;O'Reilly, 1986;Kaplan, 1989;Cock-re11 and Hendron, 1990). Since the entire ureter is not usually seen on initial IVU (in the present series the ureter was visualised fully in only 2 cases) a retrograde contrast study is necessary.…”

“…Retrograde ureterography requires cystoscopy, is usually carried out under general anaesthesia and predisposes to iatrogenic infection of an already obstructed system-a situation which may result in failure of the pyeloplasty or loss of the kidney (O'Reilly and Richards, 1986). The justification for full ureteric visualisation is the rare but potentially troublesome situation of a pyeloplasty being performed for suspected PUJ obstruction which fails because of a missed primary megaureter or an obstructing radiolucent stone in the distal ureter (O'Reilly, 1986). Cockrell and Hendren (1990) reported 100 paediatric patients who underwent pyeloplasty for PUJ obstruction and stressed the importance of pre-operative visualisation of the entire ureter using contrast.…”

“…Retrograde ureterography, however, is still commonly performed despite the risks inherent in instrumenting an obstructed system. It is felt that the entire ureter should be visualised with contrast medium before pyeloplasty Accepted for publication 3 December 1991 to ensure that no other coincidental ureteric abnormality is missed either preor per-operatively (Anderson, 1963;O'Reilly, 1986;Kaplan, 1989;Wolpert et al, 1989;Cockrell and Hendron, 1990).…”

Effective Intubation for Percutaneous Pyelolysis

“…These discrepancies are undoubtedly multifactorial and reflect the non-conformity of selection for surgery, the techniques of pyelolysis and intubation, and the method applied for follow-up [12], Diuretic renography is a freely available and well-proven technique for the diagnosis of pelvic outflow obstruction [7], It is also repeatable and reproducible for the follow-up of decom pressive surgery, in all except the grossest of hydrone phroses when direct pressure measurement techniques are necessary [13]. These diagnostic criteria were applied for the selection and follow-up of our patients with pel vic outflow obstruction.…”