Utility of ureteric jet: A simple yet useful tool for the evaluation of complex urogenital anomaly

In infants and young children with suspicion of genitourinary tract anomalies, ultrasonography (USG) is usually the first imaging modality. Advantages of USG are well described. In the evaluation of complex congenital urogenital anomalies, ultrasound examination needs to be tailored according to the clinical suspicion and to yield maximum information. Primary megaureter is a congenital anomaly, which is associated with dilatation of ureter above an adynamic segment at the vesicoureteric junction (VUJ). Two different types are described in the literature: refluxing and obstructive. Absence of ureteric jet on USG in conjunction with vesicoureteric reflux (VUR) on voiding cystourethrogram (VCUG) prompts to the diagnosis of refluxing type of obstructed megaureter. Here we describe a case of duplex moiety with refluxing type of obstructed megaureter, where gray-scale USG and real-time color Doppler evaluation of the ureteric jet established the diagnosis. The aperistaltic segment of lower ureter near the VUJ with an absence of ureteric jet for the same moiety suggested the possibility of an obstructed megaureter. VUR was demonstrated on VCUG; thus, pointing toward a diagnosis of obstructed refluxing megaureter.