Antenatal hydronephrosis (ANH) is one of the most common abnormal findings detected on prenatal ultrasound (US), and it has been reported in 1-5% of all pregnancies. The likelihood of significant postnatal pathologic abnormality in the urinary tract correlates with the degree of anterior-posterior diameter (APD) according to the gestational age. Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. There is no clear consensus on the extent and mode of postnatal imaging after a diagnosis of ANH. US is the mainstay of the postnatal evaluation and helps guide further testing with voiding cystourethrography (VCUG) and diuretic renography. Although most algorithms continue to recommend generous VCUG for identification of lower urinary tract anomalies, VCUG may be safely reserved for high grade ANH cases or any grade of ANH with dilated distal ureter without increasing the risk of urinary tract infection (UTI). There are conflicting studies about efficacy of postnatal prophylactic antibiotics. It still seems reasonable to consider use of a prophylactic antibiotic to prevent infant UTIs in high-risk populations, such as females and uncircumcised males with high grades of hydronephrosis, hydroureteronephrosis, or vesicouretral reflux.
Anti-Bacterial Agents ; Child ; Consensus ; Diagnosis ; Diagnostic Imaging ; Female ; Gestational Age ; Humans ; Hydronephrosis* ; Infant ; Male ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Radioisotope Renography ; Ultrasonography ; Ureter ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urinary Tract Infections

Antenatal hydronephrosis (ANH) is one of the most common abnormal findings detected on prenatal ultrasound (US), and it has been reported in 1-5% of all pregnancies. The likelihood of significant postnatal pathologic abnormality in the urinary tract correlates with the degree of anterior-posterior diameter (APD) according to the gestational age. Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. There is no clear consensus on the extent and mode of postnatal imaging after a diagnosis of ANH. US is the mainstay of the postnatal evaluation and helps guide further testing with voiding cystourethrography (VCUG) and diuretic renography. Although most algorithms continue to recommend generous VCUG for identification of lower urinary tract anomalies, VCUG may be safely reserved for high grade ANH cases or any grade of ANH with dilated distal ureter without increasing the risk of urinary tract infection (UTI). There are conflicting studies about efficacy of postnatal prophylactic antibiotics. It still seems reasonable to consider use of a prophylactic antibiotic to prevent infant UTIs in high-risk populations, such as females and uncircumcised males with high grades of hydronephrosis, hydroureteronephrosis, or vesicouretral reflux.
Anti-Bacterial Agents ; Child ; Consensus ; Diagnosis ; Diagnostic Imaging ; Female ; Gestational Age ; Humans ; Hydronephrosis* ; Infant ; Male ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Radioisotope Renography ; Ultrasonography ; Ureter ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urinary Tract Infections

A study was conducted to validate the Inoue protocol in determining the glomerular filtration rate (GFR) of Filipinos. Dynamic posterior planar kidney images of 402 consecutive Filipino patients referred for in vitro GFR determination were reprocessed using the Inoue protocol. Regression and Bland-Altman analyses were done on surface area normalized glomerular filtration rates (GFRSAnorm) generated using the Inoue linear regression model of the sample, Gates' method, and original regression formula published by Inoue, using respective two-point plasma concentration (in vitro) GFRSAnorm values as reference standards. GFRSAnorm results from the three camera-based techniques had strong correlation with those obtained using the in vitro method (i.e. r values of 0.9349, 0.8922 and 0.9349, respectively). However, agreement analysis showed lack of both bias and precision in the results of the Inoue linear regression model of the sample, and presence of bias and lack of precision in the results of both the Gates' method and the original linear regression model published by Inoue when compared to their corresponding in vitro GFRSAnorm results (standard error of 0.6209, 0.8379 and 0.9473, respectively). Thus, the linear regression model of the Inoue protocol is superior to the Gates' method for camera-based GFR estimation, and is population-specific, but is not robust enough to be a replacement for the in vitro technique.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Bias (epidemiology) ; Glomerular Filtration Rate ; In Vitro Techniques ; Kidney ; Linear Models ; Radioisotope Renography

INTRODUCTIONThis study aimed to ascertain whether nonopacified kidney on excretory urography (also known as intravenous urography [IVU]) indicates nonsalvageability.

METHODSWe retrospectively reviewed 45 adult patients with chronic unilateral urinary tract obstruction, in whom IVU revealed nonopacified kidney on one side but normal excretion on the contralateral side. Affected kidneys with split glomerular filtration rate (GFR) < 10 mL/min/1.73 m2 on 99mTc-diethylenetriaminepentaacetic acid diuretic renal scintigraphy were considered nonsalvageable. Non-function was defined based on cutoff points (< 15% and < 20%) to determine the sensitivity and specificity of differential renal function. Differences in IVU and renal scintigraphy findings, with respect to the duration of delayed filming on IVU, were analysed for significance.

RESULTSThe results of IVU and renal scintigraphy findings for 34 (75.6%) nonopacified kidneys matched, representing nonsalvageable kidneys. Sensitivity and specificity of differential renal function were 76% and 100%, respectively, when the cutoff point for non-function was set at < 15%. Sensitivity and specificity were 97% and 82%, respectively, when the cutoff point was < 20%. There was no significant difference between renal scintigraphy findings and IVU with 2-hour and > 2-hour delayed films (p = 0.96).

CONCLUSIONAlthough most nonopacified kidneys on IVU were nonsalvageable, a quarter of them were found to be salvageable on renal scintigraphy. Besides split GFR, differential function at cutoff point < 15% could be used to determine non-function of a chronic obstructed kidney when the contralateral kidney is normal. Delayed filming beyond two hours appears unnecessary in ensuring non-excretion on IVU.

Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Glomerular Filtration Rate ; Humans ; Kidney ; diagnostic imaging ; Kidney Diseases ; diagnostic imaging ; therapy ; Kidney Function Tests ; Male ; Middle Aged ; Pentetic Acid ; Radioisotope Renography ; methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Technetium ; Treatment Outcome ; Ureteral Obstruction ; diagnostic imaging ; therapy ; Urography ; methods

PURPOSE: To evaluate 99mTc-mercaptoacetyltriglycine diuretic renograms for diagnosing stomal obstruction in tubeless cutaneous ureterostomy. MATERIALS AND METHODS: Cutaneous ureterostomy was performed in 29 patients (56 renal units) with a minimum follow-up period of 12 months. Stomal obstruction was evaluated with 99mTc-mercaptoacetyltriglycine diuretic renography 3 months after surgery. Regions of interest were drawn that completely encircled and snugly fit the kidney, renal pelvis, and ureter. The data analyses were performed with half-times to tracer clearance following furosemide (0.5 mg/kg) administration. RESULTS: The mean half-times to tracer clearance were 6.90+/-6.30, 5.25+/-4.29, and 8.75+/-7.63 minutes in the total, ipsilateral, and contralateral kidneys, respectively, in side relationships between the ureter and the stoma. There were significant differences between the ipsilateral and contralateral kidneys in the mean half-time to tracer clearance (p=0.038). Forty-eight renal units (85.7%) had a half-time to tracer clearance of less than 15 minutes, and all 48 renal units had no hydronephrosis. On the other hand, 5 renal units (8.9%) had a half-time to tracer clearance of more than 20 minutes, and these 5 renal units required the insertion of stent catheters or became atrophic. CONCLUSIONS: 99mTc-mercaptoacetyltriglycine diuretic renography was very useful for diagnosing stomal obstruction of tubeless cutaneous ureterostomy. The upper limit of the half-time to tracer clearance for unobstructed systems was 15 minutes, which allowed for the confident exclusion of stomal obstruction in tubeless cutaneous ureterostomy.
Catheters ; Follow-Up Studies ; Furosemide ; Hand ; Humans ; Hydronephrosis ; Kidney ; Kidney Pelvis ; Radioisotope Renography ; Statistics as Topic ; Stents ; Technetium Tc 99m Mertiatide ; Ureter ; Ureteral Obstruction ; Ureterostomy ; Urinary Bladder Neoplasms

This study was performed to investigate the proper method for evaluating renal function in miniature pigs with unilateral ureteral obstruction. Experimental unilateral renal damage was induced after ligation of unilateral right ureter in 3 miniature pigs. On the 3rd post-operative day, scintigraphic images were obtained after 12 mCi of 99mTc-diethylentriamene pertaacetate (DTPA) intravenous injection. Renography showed that radiopharmaceutical uptakes in the right kidney were lower than those of left kidney uptakes as early as at 3 days after surgical operation. The static images of 99mTc-DTPA enabled us to measure the relative renal function in miniature pigs with unilateral ureteral obstruction. In conclusion, renography using 99mTc-DTPA was the useful diagnostic method to evaluate the renal function in miniature pigs.
Injections, Intravenous ; Kidney ; Ligation ; Radioisotope Renography ; Swine ; Ureter ; Ureteral Obstruction

Crossed renal ectopia is a congenital malformation in which both kidneys lie on the same side of the spine, usually side by side longitudinally. More often on the right side. Fusion of the two renal units is eight times more common than nonfusion. Although crossed renal ectopia is uncommon, this unusual entity must be considered in an infant when cystic mass in the abdomen or pelvis paticularly if no kidney can be found on the opposite side. In many cases of crossed fused ectopia with multicystic dysplastic kidney(MCDK), the diagnosis can be strongly suspected from the sonogram, and no other studies may be necessary. However, both intravenous urography and isotope renography is useful to assess the function of the crossed kidney. Crossed renal ectopia and MCDKs are associated with a greater incidence of ureteropelvic junction obstruction and reflux. So, screening voiding cystourethrography should be performed. Very few studies of MCDK in the setting of crossed fused ectopia have been reported. We have experienced a 3-year-old boy with crossed fused renal ectopia with multicystic dysplasia.
Abdomen ; Humans ; Incidence ; Infant ; Kidney ; Mass Screening ; Multicystic Dysplastic Kidney ; Pelvis ; Preschool Child ; Radioisotope Renography ; Spine ; Urography

PURPOSE: Non conservative treatment such as heminephrectomy is considered the treatment of choice when the upper pole kidney in children with a complete ureteral duplication complicated with ureterocele or ectopic ureter is nonfunctional. The postoperative outcome of the upper pole kidney with a complete ureteral duplication after pyeloureterostomy was evaluated, and we focused on those children with undetected functions on the upper pole kidney before surgery. MATERIALS AND METHODS: Between May 2002 and March 2006, we evaluated 28 children, 10 boys and 18 girls, who had undergone pyeloureterostomy for a complete ureteral duplication that was complicated with ureterocele or ectoplic ureter. Their mean age was 12.3 months. Ultrasound, 99mTc-dimercaptosuccinic acid(DMSA) scanning and voiding cystourethrography(VCUG) were performed preoperatively. The clinical courses were followed up with ultrasound at 1, 3, 6 and 12 months, and DMSA scanning was done between 6 and 12 months after surgery. The median follow-up period was 21.5 months. RESULTS: Among the 12 children with cortical thinning seen on ultrasound, 10 showed thickening of the renal cortex within 12 months. All 16 children with Grade III or less hydronephrosis on the upper pole kidney were downgraded, and 10 out of them showed complete resolution or Grade I hydronephrosis within 6 months. 4 cases with no visible photon uptake at the upper pole kidney preoperatively showed hot uptakes at the defective spot between 6 to 12 months after pyeloureterostomy. 5 out of 28 children had urinary tract infection(UTI) within 3 months after surgery; however, this was easily controlled with oral antibiotics. CONCLUSIONS: The function of the upper pole kidney is recovered within 1 year after pyeloureterostomy in most of the cases with a complete ureteral duplication, regardless of the severity of hydronephrosis at the upper pole kidney. Pyeloureterostomy can be an alternative treatment modality for treating a complete ureteral duplication that's complicated with ureterocele or ectopic ureter due to pyeloureterostomy's lower morbidity compared to non-conservative surgery such as heminephrecotmy.
Anti-Bacterial Agents ; Child ; Female ; Follow-Up Studies ; Humans ; Hydronephrosis ; Kidney* ; Radioisotope Renography ; Succimer ; Ultrasonography ; Ureter* ; Ureterocele* ; Urinary Tract

PURPOSE: Endourological management of ureteropelvic junction obstruction (UPJO) has gained increased acceptance with high procedural success rates and low morbidity being reported. It has been suggested that Acucise endopyelotomy should be the procedure of choice for patients with UPJO. The purpose of this study is to determine the efficacy of the Acucise balloon for the treatment of ureteral strictures and UPJO. MATERIALS AND METHODS: Between March 2004 and June 2005, 13 consecutive patients (8 primary and 5 secondary cases of UPJO) underwent Acucise endopyelotomy at our institution. The preoperative evaluation included ultrasound and/or intravenous urogram with diuretic renography. The success of the procedure was based on objective radiologic improvement and the subjective resolution of symptoms. RESULTS: The mean follow-up was 6.77+/-3.83 months (range: 3-14). The mean operating time was 64.23+/-34.87 min and the mean hospital stay was 4.15+/-2.44 days. The objective success rate was 61.5% and the subjective success rate was 69.2%. There were no major complications such as vascular injury requiring transfusion. Yet a small urinoma developed in one patient. Of the 5 objective failures, 3 patients have since successfully undergone open pyeloplasty. CONCLUSIONS: In this small series, Acucise endopyelotomy is a safe and minimally invasive procedure that offered effective first-line treatment for UPJO, although multicenter randomized trials are needed to make a better comparison with the other techniques.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Length of Stay ; Radioisotope Renography ; Ultrasonography ; Ureter* ; Ureteral Obstruction ; Urinoma ; Urologic Surgical Procedures ; Vascular System Injuries

PURPOSE: We report on the standards for determining the obstructive type and the non-obstructive type of primary non-refluxing megaureter, and we also report on the diagnostic and therapeutic approach for such patients. MATERIALS AND METHODS: We evaluated 28 children diagnosed with primary non-refluxing megaureter from Jan 2000 to Feb 2003. We assessed the changes in hydronephrosis and dilated ureteral diameter at 2 and 6 months after surgery (the surgery group) and on the diagnosed 'wait and see' group. RESULTS: Out of 28 children, 14 children underwent ureteroneocystostomy. The mean diameter of the dilated ureter was decreased significantly from 20.3mm at initial presentation to 9.3mm and 3.4mm at 2 and 6 months, respectively, after surgery in the surgery group (p=0.0063, 0.0027), and from 21.1mm to 6.7mm and 4.8mm at 2 and 6 months, respectively, after diagnosis in the 'wait and see' group (p=0.0247, 0.0154). The mean grade of hydronephrosis was decreased significantly from 3.6 to 2.7 and 2.13, respectively, in the surgery group (p=0.0044, 0.0003), and from 2.35 to 1.53 and 1.12, respectively, in the 'wait and see' group (p=0.0026, 0.0006). However, the difference in the percentage of decrease in the mean ureteral diameter and the grade of hydronephrosis compared to the values at the initial presentation was not significant between the two groups (p=0.4168, 0.8999). When diuretic renography (DRG) was done in the surgery group, only 15 ureters (20%) showed an obstructive pattern with T1/2 above 20 minutes. CONCLUSIONS: The discrimination of obstruction and non-obstruction is the most important factor for the prognosis and treatment plan of primary non-refluxing megaureter. It is possible to correctly evaluate this condition by comparison of the change in the pattern of disease through continuous, periodic evaluation and follow-up. Surgical treatment such as ureteroneocystostomy must be considered when breakthrough urinary tract infection (UTI), aggravation of hydronephrosis or marked decrease of renal function is present during conservative treatment or observation.
Child ; Classification* ; Diagnosis ; Discrimination (Psychology) ; Follow-Up Studies ; Humans ; Hydronephrosis ; Prognosis ; Radioisotope Renography ; Replantation ; Ureter ; Urinary Tract Infections