Intermittent hydronephrosis: the occult ureteropelvic obstruction

Area of Science:

• Urology
• Diagnostic Imaging

Background:

• Occult ureteropelvic junction obstruction presents with intermittent pain and normal-appearing upper urinary tracts on standard urography.
• This condition is often challenging to diagnose, leading to delayed treatment.

Purpose of the Study:

• To evaluate the efficacy of infusion excretory urography with furosemide stimulation in diagnosing occult ureteropelvic junction obstruction.
• To highlight the diagnostic value of this technique in patients with intermittent upper urinary tract obstruction.

Main Methods:

• Infusion excretory urography with furosemide stimulation was performed on 10 patients with suspected occult obstruction.
• Urographic findings and pain reproduction during diuresis were analyzed.

Main Results:

• Occult ureteropelvic junction obstruction was confirmed in 10 patients (3 children, 7 adults), representing 3.4% of pyeloplasty cases over 10 years.
• Furosemide-stimulated urography dramatically demonstrated the obstruction in all patients.
• The technique was particularly useful for lateralizing obstruction in cases with bilateral symmetry and reproducing pain via diuresis.

Conclusions:

• Infusion excretory urography with furosemide stimulation is a highly effective method for diagnosing occult ureteropelvic junction obstruction.
• This diagnostic approach aids in identifying an often elusive cause of intermittent upper urinary tract pain.