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Doppler ultrasound in pelviureteric junction obstruction in infants and children
W Kincaid1, A S Hollman, A F Azmy
1Department of Diagnostic Radiology, Royal Hospital for Sick Children, Glasgow, Scotland.
Insights
Doppler ultrasound with diuretic (frusemide) effectively assesses pediatric pelviureteric junction obstruction by measuring renal artery resistance index changes, aiding surgical outcome prediction.
Area of Science:
- Pediatric Nephrology
- Medical Imaging
- Urology
Background:
- Pelviureteric junction (PUJ) obstruction is a common congenital anomaly in infants and children.
- Accurate diagnosis and assessment of PUJ obstruction are crucial for timely intervention and optimal outcomes.
- Non-invasive imaging techniques are preferred for pediatric assessments.
Purpose of the Study:
- To evaluate the utility of Doppler ultrasound with diuresis in assessing pelviureteric junction obstruction in pediatric patients.
- To determine if Doppler ultrasound can predict surgical outcomes following pyeloplasty.
Main Methods:
- Doppler ultrasound was performed on 13 pediatric patients (6 infants, 7 children) with known PUJ obstruction before and after intravenous frusemide administration.
- The resistance index (RI) in the interlobar renal arteries of obstructed and normal kidneys was measured.
- Five patients were reassessed post-pyeloplasty.
Main Results:
- A significant increase in RI was observed in the interlobar renal arteries of obstructed kidneys after frusemide.
- No significant RI change was noted in normal contralateral kidneys.
- Doppler indexes post-surgery correlated with satisfactory outcomes.
Conclusions:
- Doppler ultrasound combined with diuresis is a valuable tool for assessing pediatric PUJ obstruction.
- This method aids in evaluating the severity of obstruction and predicting postoperative success.
- It offers a useful approach for both initial assessment and postoperative follow-up.
Abstract:
Six infants and seven children with known pelviureteric junction (PUJ) obstruction (11 unilateral, 2 bilateral) were assessed with Doppler ultrasound before and after diuresis. After intravenous frusemide, there was a significant increase in the resistance index in the interlobar renal arteries of the obstructed kidneys. No such change was detected in the normal kidneys. Five patients were reassessed after pyeloplasty. The Doppler indexes facilitated prediction of those cases with a satisfactory outcome after surgery. Doppler ultrasound with diuresis is useful in the assessment of PUJ obstruction in infants and children and in the postoperative follow-up.