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Does every patient with ureteropelvic junction obstruction need voiding cystourethrography?
1Departments of Urology and Radiology, Yonsei University College of Medicine, Seoul, Korea.
The Journal of Urology
|May 24, 2001
Summary
Voiding cystourethrography is not always necessary for children with ureteropelvic junction obstruction. Low-grade reflux often resolves spontaneously after pyeloplasty, while high-grade reflux is detectable via ultrasonography.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nephrology
Background:
- Ureteropelvic junction obstruction is a common congenital anomaly in children.
- Vesicoureteral reflux (VUR) is frequently evaluated in these patients.
- The role of voiding cystourethrography (VCUG) in diagnosing VUR alongside ureteropelvic junction obstruction (UPJO) requires clarification.
Purpose of the Study:
- To assess the incidence and natural history of VUR in children diagnosed with UPJO.
- To evaluate the diagnostic utility of VCUG in this patient population.
- To determine the optimal indications for VCUG in children with UPJO.
Main Methods:
- Retrospective review of 106 children (<15 years) who underwent pyeloplasty for UPJO.
- Diagnosis of UPJO confirmed by ultrasonography and diuretic renography.
- Preoperative VCUG performed in all patients; reflux graded based on ureteral dilation.
Main Results:
- Vesicoureteral reflux was identified in 12 children (19 ureters).
- Low-grade reflux (6 cases) resolved spontaneously post-pyeloplasty.
- High-grade reflux (6 cases) required antireflux surgery and was detectable via ultrasonography.
Conclusions:
- Low-grade VUR associated with UPJO typically resolves spontaneously after pyeloplasty.
- High-grade VUR in UPJO cases is readily identified by ultrasonography.
- VCUG indication in UPJO should be reserved for cases with ultrasonographically detected dilated ureters.