Related Experiment Videos
[Congenital valves of the ureter. Comments on 7 cases studied in childhood]
M Di Mario1, R Fruhwirth, D Barbuti
1Servizio di Radiologia, Ospedale Pediatrico Bambino Gesù, Roma.
Insights
Ureteral valves, a rare cause of pediatric obstructive uropathy, require accurate diagnosis. This study highlights intravenous urography and segmental ascending pyelography as key diagnostic tools, leading to successful surgical outcomes and recovery.
Area of Science:
- Pediatric Radiology
- Urology
- Congenital Abnormalities
Background:
- Ureteral valves are an uncommon cause of congenital obstructive uropathy in children.
- Symptoms vary based on the severity of obstruction.
Purpose of the Study:
- To describe the clinico-radiological approach for diagnosing ureteral valves.
- To evaluate the effectiveness of diagnostic techniques and surgical treatment.
Main Methods:
- Retrospective review of 7 pediatric cases with ureteral valves.
- Utilized various imaging techniques including ultrasound (US) and intravenous urography (IVU).
- Employed segmental ascending pyelography for detailed ureteral visualization.
Main Results:
- Intravenous urography was highly sensitive for confirming US-detected obstruction and pinpointing its location.
- Segmental ascending pyelography identified additional valves and visualized ureteral segments above and below strictures.
- All 7 patients showed symptom regression and improved ureteral function post-surgery.
Conclusions:
- Accurate diagnosis of ureteral valves is crucial for effective management.
- A combination of US, IVU, and segmental ascending pyelography aids in diagnosis.
- Surgical intervention leads to favorable functional and morphological recovery in pediatric patients.
Abstract:
Ureteral valves are a rare cause of congenital obstructive uropathy in pediatric age. Symptoms onset is variable and depends directly on the degree of valvular obstruction. Seven cases of ureteral valves were studied in the Radiology Department of "Bambino Gesù" Pediatric Hospital in Rome; every type of technique available in the hospital was employed. For each case, the authors carefully describe the clinico-radiological approach which led to the diagnosis of obstruction due to the presence of one or more valvular structures (hydronephrosis). Intravenous urography proved to be the most sensitive examination to confirm the diagnosis of suspected obstruction made on the basis of US findings, and to assess its precise location. Segmental ascending pyelography was also employed, which consists in cystoscopically inserting a ureteral catheter into the renal pelvis, and then administering a contrast medium which allows the fluoroscopic visualization, both above and below the stricture, of the ureteral segments. The technique also allows the detection of other valves of the same ureter not otherwise recognizable. All 7 patients underwent surgery; follow-up at 12 months demonstrated clinical symptoms regression and a good functional and morphological recovery of the involved ureter.