Upper urinary tract obstruction in children: current controversies in diagnosis.
Our approach to the evaluation and treatment of children with upper urinary tract obstruction is shown in Figure 10. The following guiding principles should be remembered: 1. Intravenous urography and renal ultrasonography are usually insufficient to establish the diagnosis of obstruction in an asymptomatic patient. 2. Diuresis-enhanced renography is diagnostic in nonobstructed systems (spontaneous excretion of the radioisotope before the injection of furosemide) or unequivocally obstructed systems (no excretion of the radioisotope after injection of furosemide). 3. If the results of diuresis-enhanced renography are equivocal, a patient should be evaluated by pressure flow studies before surgical correction is undertaken or a diagnosis of no obstruction. 4. Diuresis-enhanced renography is extremely useful in followup and in evaluating surgical results.
Reinberg
Y
Y
Department of Urologic Surgery, University of Minnesota Hospital and Clinic, Minneapolis.
Gonzalez
R
R
D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007668:Kidney / Q000473:pathology; D011866:Radioisotope Renography; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014517:Ureteral Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014563:Urodynamics; D014567:Urography