Imaging for ureteropelvic junction obstruction in adults

The three goals of imaging for ureteropelvic junction (UPJ) obstruction are to determine the presence and degree of renal obstruction, to assess renal function, and to determine the cause of the problem. The diagnostic techniques are intravenous urography, which is unreliable; ultrasonography, with the addition of pulsed Doppler technology; diuretic scintigraphy; and pressure-flow studies (Whitaker test), which is the only direct clinical test of renal outflow resistance. Voiding cystography, retrograde ureteropyelography, and CT have utility in some patients. In determining the cause of obstruction, the patient often is evaluated for crossing vessels using angiography, endoluminal ultrasonography, or spiral CT. It is not possible to formulate a single algorithm for radiographic evaluation of suspected UPJ obstruction, but in the average adult patient, urography and diuretic scintigraphy are sufficient.