title: The role of voiding cystourethrography in asymptomatic unilateral isolated ureteropelvic junction obstruction: A retrospective study.
abstract: BACKGROUND
  The presence of concomitant vesicoureteric reflux (VUR) and ureteropelvic junction obstruction (UPJO) is uncommon. Nevertheless, the reported VUR coexisting with asymptomatic unilateral isolated hydronephrosis (AUIH) requiring pyeloplasty for correction of UPJO was of low grade and mostly resolved during conservative follow-up. Therefore, VCUG may be not indicated in these children except if voiding symptoms, urinary tract infection (UTI), dilated ureters, or bladder and ureteric abnormalities are suspected.
  
  
  OBJECTIVE
  The aim was to evaluate the need for VCUG in infants <1 year old with AUIH for whom a dismembered pyeloplasty was indicated for correction of UPJO.
  
  
  METHODS
  Ninety-six children <1 year old with pyeloplasty carried out from January 2012 to March 2014 were retrospectively included. Children with voiding symptoms or dilated ureter, duplex system, fused kidneys, bilateral dilatation, or any bladder abnormality on ultrasound were excluded. Anderson-Hynes pyeloplasty was performed through a flank incision. Preoperative VCUG was analyzed in relation to outcome and any UTI during follow-up. The Student t test, Mann-Whitney U test, or Fisher exact test were used to compare variables.
  
  
  RESULTS
  Five children had concomitant VUR with UPJO. Most of the children were circumcised during the first postnatal week. The remaining few children were circumcised at the time of pyeloplasty. Side, grade of detected VUR, and complications (18.75%) (postoperative or during follow-up) are presented in the Table. Outcomes in children with and without VUR were not different. Dismembered pyeloplasty was successful in children with VUR and with no complications except for non-febrile UTI in one child only. Ureters were still not dilated at the last follow-up.
  
  
  CONCLUSIONS
  The required imaging in infants with AUIH is still a subject of debate. As we expected, there was a low incidence of associated VUR in the present study. They were of low grade without any complications during follow-up and without affecting the outcome. The present study has its limitations, including the retrospective nature and short follow-up. However, as at least 2 years of follow-up were documented without any harm or ureteric dilation, VUR will mostly resolve. The present study is strengthened by inclusion of infants only.
  
  
  CONCLUSIONS
  Our data suggest that VCUG is not indicated in infants with AUIH requiring pyeloplasty for correction of UPJO. VCUG will not affect the treatment decision, operative outcome, or postoperative complications. VCUG may be indicated in case of suspected voiding symptoms, UTI, dilated ureters, or bladder and ureteric abnormalities.
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt. Electronic address: mohammedshemy@yahoo.com.
authors.forename: Mohammed S
authors.initials: MS
authors.lastname: ElSheemy
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Waleed
authors.initials: W
authors.lastname: Ghoneima
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdelwahhab
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Waseem
authors.initials: W
authors.lastname: Aboulela
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Kareem
authors.initials: K
authors.lastname: Daw
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Shouman
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Shoukry
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Ghoneimy
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Hany A
authors.initials: HA
authors.lastname: Morsi
authors.affiliation: Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Badawy
mesh_terms: D000367:Age Factors; D058070:Asymptomatic Diseases; D000070621:Cystography / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D007223:Infant; D007682:Kidney Pelvis / Q000601:surgery*; D008297:Male; D000074643:Nephrotomy / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States; D019564:Unnecessary Procedures; D014517:Ureteral Obstruction / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D014521:Urethra / Q000000981:diagnostic imaging*; D014554:Urination / Q000502:physiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*
keywords: Concomitant VUR and UPJO; Infants; Isolated hydronephrosis; Non-dilated ureters; Voiding cystourethrography