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IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
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Voiding Cystourethrogram Before Pyeloplasty: To Do or Not To Do?

Ismail Selvi1, M İrfan Dönmez1, Enes Değirmenci1

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Approximately 9% of pediatric patients with ureteropelvic junction obstruction (UPJO) also have concomitant vesicoureteral reflux (VUR). Factors like febrile urinary tract infection, higher anteroposterior diameter (APD), and lower parenchymal thickness (PT) predict VUR.

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Area of Science:

  • Pediatric Urology
  • Nephrology
  • Medical Imaging

Background:

  • Ureteropelvic junction obstruction (UPJO) is a common cause of congenital hydronephrosis in children.
  • Vesicoureteral reflux (VUR) is another significant condition that can lead to kidney damage.
  • The co-occurrence of UPJO and VUR requires careful diagnostic and management strategies.

Purpose of the Study:

  • To determine the incidence of VUR in pediatric patients with unilateral UPJO.
  • To identify clinical and sonographic factors that predict the presence of VUR in these patients.

Main Methods:

  • Retrospective review of 381 pediatric patients who underwent unilateral pyeloplasty (2000-2017).
  • Analysis of 270 eligible patients with at least 5 years of follow-up.
  • Data collected included demographics, hydronephrosis grade, renal pelvis anteroposterior diameter (APD), parenchymal thickness (PT), and VUR status.

Main Results:

  • Concomitant VUR was found in 8.9% of patients (24/270).
  • Predictive factors for VUR included presentation with febrile urinary tract infection (UTI), lower parenchymal thickness (PT < 3.95 mm), and higher anteroposterior diameter (APD > 28.8 mm).
  • Higher grade VUR (III-V) was observed in 75% of affected patients, with 50% having ipsilateral VUR.

Conclusions:

  • Concomitant VUR occurs in approximately 1 in 11 pediatric patients with UPJO undergoing pyeloplasty.
  • Preoperative voiding cystourethrogram may be particularly valuable in patients with febrile UTI, higher APD, and lower PT.
  • 75% of patients with concomitant VUR required surgical intervention for VUR.