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Obstructive diseases of the urinary tract in children: lessons from the last 15 years
1Department of Radiology, Division of Pediatric Radiology, University Hospital LKH Graz, Auenbruggenplatz, 8036 Graz, Austria. michael.riccabona@meduni-graz.at
Insights
Diagnosing paediatric urinary tract obstruction requires careful imaging to identify kidneys needing surgery. Current methods, including ultrasound and MR-urography, still necessitate follow-up due to a lack of definitive predictive assessments.
Area of Science:
- Paediatric uroradiology
- Medical imaging
- Nephrology
Background:
- Imaging plays a crucial role in evaluating paediatric urinary tract obstruction.
- The goal is to differentiate kidneys requiring surgical intervention from those that can be managed conservatively.
- Advancements in imaging, such as diuretic paediatric MR-urography, have been introduced.
Purpose of the Study:
- To assess the current state of imaging for paediatric urinary tract obstruction.
- To highlight the challenges in predicting future kidney function and growth potential.
- To discuss the role of various imaging modalities in monitoring and decision-making.
Main Methods:
- Review of current imaging practices in paediatric uroradiology for urinary tract obstruction.
- Discussion of modalities including ultrasound (US), diuretic renal scintigraphy, and MR-urography.
- Mention of the declining use of intravenous urography (IVU) and the Whitaker test.
Main Results:
- Despite advancements, a reliable method for a priori prediction of future kidney outcomes is still lacking.
- Repeated follow-up imaging is frequently required for effective monitoring.
- Institutional protocols for imaging frequency and surgical criteria vary.
Conclusions:
- Accurate, long-term prognostication for paediatric urinary tract obstruction remains a challenge.
- A combination of imaging techniques, particularly US, diuretic scintigraphy, and MR-urography, are essential.
- Further research may be needed to develop more definitive predictive assessment tools.
Abstract:
Imaging urinary tract obstruction is a common query in paediatric uroradiology. With the advent of a more conservative treatment approach, the task of imaging today is to distinguish as early as possible those kidneys that do not require surgery, from those that will deteriorate and lose function and/or growth potential and thus benefit from surgery. At present, in spite of significant advancements in imaging and the introduction of diuretic paediatric MR-urography, there is still no reliable a-priori pro-futuro assessment. Thus, repeated follow-up imaging is often necessary for monitoring. Imaging usually starts with US; the major additional complementary and more function-oriented tools are diuretic renal scintigraphy and MR-urography. The frequency and timing as well as the detailed protocol vary within institutions, partly because of differences in the criteria that are used for indicating surgery. Intra-venous urography (IVU) for obstruction has practically vanished apart from for a few exceptions, and the "Whitaker" test is today seldom performed, being reserved for complicated cases.
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