Skip to main content

Advertisement

Log in

Obstructive diseases of the urinary tract in children: lessons from the last 15 years

  • Review
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Imaging urinary tract obstruction is a common query in paediatric uroradiology. With the advent of a more conservative treatment approach, the task of imaging today is to distinguish as early as possible those kidneys that do not require surgery, from those that will deteriorate and lose function and/or growth potential and thus benefit from surgery. At present, in spite of significant advancements in imaging and the introduction of diuretic paediatric MR-urography, there is still no reliable a-priori pro-futuro assessment. Thus, repeated follow-up imaging is often necessary for monitoring. Imaging usually starts with US; the major additional complementary and more function-oriented tools are diuretic renal scintigraphy and MR-urography. The frequency and timing as well as the detailed protocol vary within institutions, partly because of differences in the criteria that are used for indicating surgery. Intra-venous urography (IVU) for obstruction has practically vanished apart from for a few exceptions, and the “Whitaker” test is today seldom performed, being reserved for complicated cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Gordon I, Riccabona M (2003) Investigating the newborn kidney—update on imaging techniques. Semin Neonatol 8:269–278

    Article  PubMed  Google Scholar 

  2. Riccabona M (2006) Imaging the neonatal genito-urinary tract. Eur J Radiol 60:187–198

    Article  PubMed  Google Scholar 

  3. Riccabona M, Fotter R (2004) Reorientation and future trends in paediatric uroradiology: minutes of a symposium held in Graz, 5–6 September 2002. Pediatr Radiol 34:295–301

    Article  PubMed  Google Scholar 

  4. Ek S, Lidefeldt KJ, Varricio L (2007) Fetal hydronephrosis; prevalence, natural history and postnatal consequences in an unselected population. Acta Obstet Gynecol Scand 86:1463–1466

    Article  PubMed  Google Scholar 

  5. Lee RS, Cendron M, Kinnamon DD et al (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:568–593

    Google Scholar 

  6. Thomas DF (2008) Prenatally diagnosed urinary tract abnormalities: long-term outcome. Semin Fetal Neonatal Med 13:189–195

    Article  CAS  PubMed  Google Scholar 

  7. Wollenberg A, Neuhaus TJ, Willi UV et al (2005) Outcome of fetal renal pelvic dilatation diagnosed during the third trimester. Ultrasound Obstet Gynecol 25:483–488

    Article  CAS  PubMed  Google Scholar 

  8. Whitaker RH, Bullock KN, Buxton-Thomas MS et al (1982) Role of modern radiological investigations in obstructive uropathy. Br Med J (Clin Res Ed) 285:211–212

    Article  Google Scholar 

  9. Koff SA, Peller PA (1995) Diagnostic criteria for assessing obstruction in the newborn with unilateral hydronephrosis using the renal growth-renal function chart. J Urol 154:662–666

    Article  CAS  PubMed  Google Scholar 

  10. Koff SA, McDowell GC, Byard M (1988) Diuretic radionuclide assessment of obstruction in the infant: guidelines for successful interpretation. J Urol 140:1167–1168

    CAS  PubMed  Google Scholar 

  11. Peters CA (1995) Urinary tract obstruction in children. J Urol 154:1874–1884

    Article  CAS  PubMed  Google Scholar 

  12. Gordon I (2001) Diuretic renography in infants with prenatal unilateral hydronephrosis: an explanation for the controversy about poor drainage. BJU Int 87:551–555

    Article  CAS  PubMed  Google Scholar 

  13. Gordon I (2008) Diagnostic procedures: nuclear medicine. In: Fotter R (ed) Pediatric uroradiology. Springer, Berlin, pp 37–52

    Google Scholar 

  14. O’Reilly PH, Lawson RS, Shields RA et al (1979) Idiopathic hydronephrosis—the diuresis renogram: a new non-invasive method of assessing equivocal pelvioureteral junction obstruction. J Urol 121:153–155

    PubMed  Google Scholar 

  15. Piepsz A (2002) Radionuclide studies in paediatric nephro-urology. Eur J Radiol 43:146–153

    Article  PubMed  Google Scholar 

  16. Piepsz A, Ham HR (2006) Pediatric applications of renal nuclear medicine. Semin Nucl Med 36:16–35

    Article  PubMed  Google Scholar 

  17. Fernbach SK, Maizels M, Conway JJ (1993) Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol 23:478–480

    Article  CAS  PubMed  Google Scholar 

  18. Riccabona M (2002) Potential of modern sonographic techniques in paediatric uroradiology. Eur J Radiol 43:110–121

    Article  PubMed  Google Scholar 

  19. Riccabona M, Fritz GA, Schollnast H et al (2005) Hydronephrotic kidney: pediatric three-dimensional US for relative renal size assessment—initial experience. Radiology 236:276–283

    Article  PubMed  Google Scholar 

  20. Riccabona M (2006) Modern pediatric ultrasound: potential applications and clinical significance. A review. Clin Imaging 30:77–86

    Article  PubMed  Google Scholar 

  21. Riccabona M, Fotter R (2006) Radiographic studies in children with kidney disorders: what to do and when. In: Hogg R (ed) Kidney disorders in children and adolescents. Taylor and Francis, Birmingham, pp 15–34

    Google Scholar 

  22. Riccabona M, Avni FE, Blickman JG et al (2008) Imaging recommendations in paediatric uroradiology: minutes of the ESPR workgroup session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cysto-urethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145

    Article  PubMed  Google Scholar 

  23. Amis ES Jr (1999) Epitaph for the urogram. Radiology 213:639–640

    PubMed  Google Scholar 

  24. Leppert A, Nadalin S, Schirg E et al (2002) Impact of magnetic resonance urography on preoperative diagnostic workup in children affected by hydronephrosis: should IVU be replaced? J Pediatr Surg 37:1441–1445

    Article  CAS  PubMed  Google Scholar 

  25. Riccabona M, Simbrunner J, Ring E et al (2002) Feasibility of MR-urography in neonates and infants with abnormalities of the upper urinary tract. Eur Radiol 12:1442–1450

    Article  CAS  PubMed  Google Scholar 

  26. Riccabona M (2004) Pediatric MRU—its potential and its role in the diagnostic work-up of upper urinary tract dilatation in infants and children. World J Urol 22:79–87

    PubMed  Google Scholar 

  27. Chertin B, Pollack A, Rabinowitz R et al (2006) Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol 49:734–738

    Article  PubMed  Google Scholar 

  28. Estrada CR Jr (2008) Prenatal hydronephrosis: early evaluation. Curr Opin Urol 18:401–403

    Article  PubMed  Google Scholar 

  29. Perez-Brayfield MR, Kirsch AJ, Jones RA et al (2003) A prospective study comparing ultrasound, nuclear scintigraphy and dynamic contrast enhanced magnetic resonance imaging in the evaluation of hydronephrosis. J Urol 170:1330–1334

    Article  PubMed  Google Scholar 

  30. Piepsz A (2007) Antenatally detected hydronephrosis. Semin Nucl Med 37:249–260

    Article  PubMed  Google Scholar 

  31. Riccabona M (2004) Assessment and management of newborn hydronephrosis. World J Urol 22:73–78

    PubMed  Google Scholar 

  32. Riccabona M (2004) Interventional uroradiology in paediatrics: a potpourri of diagnostic and therapeutic options. Minerva Pediatr 56:497–505

    CAS  PubMed  Google Scholar 

  33. Dhillon HK (1995) Imaging and follow up of neonatal hydronephroses. Curr Opin Urol 5:75–78

    Article  Google Scholar 

  34. Ismaili K, Avni FE, Piepsz A et al (2004) Current management of infants with renal pelvis dilatation: a survey by French-speaking pediatric nephrologists and urologists. Pediatr Nephrol 19:966–971

    Article  PubMed  Google Scholar 

  35. Koff SA, Campbell KD (1994) The nonoperative management of unilateral neonatal hydonephrosis: natural history of poorly functioning kidneys. J Urol 152:593–595

    CAS  PubMed  Google Scholar 

  36. Tripp BM, Homsy YL (1995) Neonatal hydronephrosis: the controversy and the management. Pediatr Nephrol 9:503–509

    Article  CAS  PubMed  Google Scholar 

  37. Shokeir AA, Nijman RJ (2000) Antenatal hydronephrosis: changing concepts in diagnosis and subsequent management. BJU Int 85:987–994

    Article  CAS  PubMed  Google Scholar 

  38. Dhillon HL (1998) Prenatally diagnosed hydronephrosis: the Great Ormond Street experience. Br J Urol 81:39–44

    PubMed  Google Scholar 

  39. Riccabona M, Avni FE, Blickman JG et al (2009) Imaging recommendations in paediatric uroradiology, part II. Minutes of the ESPR uroradiology task force session on childhood obstructive nephropathy, high-grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. ESPR Annual Congress, Edinburgh, June 2008. Pediatr Radiol 39:891–898

    Article  PubMed  Google Scholar 

  40. Riccabona M, Avni FE, Dacher JN et al (2010) ESPR uroradiology task force and ESUR paediatric working group: imaging and procedural recommendations in paediatric uroradiology, part III. Minutes of the ESPR uroradiology task force mini-symposium on intravenous urography, uro-CT and MR-urography in childhood. Pediatr Radiol 40: in press

  41. Avni EF, Bali MA, Regnault M et al (2002) MR urography in children. Eur J Radiol 43:154–166

    Article  PubMed  Google Scholar 

  42. Borthne A, Pierre-Jerome C, Nordshus T et al (2000) MR Urography in children: current status and future development. Eur Radiol 10:503–511

    Article  CAS  PubMed  Google Scholar 

  43. Calder AD, Hiorns MP, Abhyankar A et al (2007) Contrast-enhanced magnetic resonance angiography for the detection of crossing vessels in children with symptomatic ureteropelvic junction obstruction: comparison with operative findings. Pediatr Radiol 37:356–361

    Article  PubMed  Google Scholar 

  44. Grattan-Smith JD, Perez-Bayfield MR, Jones RA et al (2003) MR imaging of kidneys: functional evaluation using F-15 perfusion imaging. Pediatr Radiol 33:293–304

    PubMed  Google Scholar 

  45. Grattan-Smith JD, Little SB, Jones RA (2008) MR urography evaluation of obstructive uropathy. Pediatr Radiol 38:S49–S69

    Article  PubMed  Google Scholar 

  46. Grattan-Smith D (ed) (2008) MR Urography in children. Pediatr Radiol 38(Suppl 1)

  47. Hackstein N, Heckrodt J, Rau WS (2003) Measurement of single-kidney glomerular filtration rate using a contrast-enhanced dynamic gradient-echo sequence and the Rutland-Patlak Plot technique. J Magn Reson Imaging 18:714–725

    Article  PubMed  Google Scholar 

  48. Jones RA, Perez-Brayfield MR, Kirsch AJ et al (2004) Renal transit time with MR urography in children. Radiology 233:41–50

    Article  PubMed  Google Scholar 

  49. Jones RA, Easley K, Little SB et al (2005) Dynamic contrast-enhanced MR urography in the evaluation of pediatric hydronephrosis: part 1, functional assessment. AJR 185:1598–1607

    Article  PubMed  Google Scholar 

  50. Kirsch AJ, McMann LP, Jones RA et al (2006) Magnetic resonance urography for evaluating outcomes after pediatric pyeloplasty. J Urol 176:1755–1761

    Article  PubMed  Google Scholar 

  51. Little SB, Jones RA, Grattan-Smith JD (2008) Evaluation of UPJ obstruction before and after pyeloplasty using MR urography. Pediatr Radiol 38:S106–S124

    Article  PubMed  Google Scholar 

  52. McDaniel BB, Jones RA, Scherz H et al (2005) Dynamic contrast-enhanced MR urography in the evaluation of pediatric hydronephrosis: part 2, anatomic and functional assessment of ureteropelvic junction obstruction. AJR 185:1608–1614

    Article  PubMed  Google Scholar 

  53. Ozcan Z, Anderson PJ, Gordon I (2002) Assessment of regional kidney function may provide new clinical understanding and assist in treatment of children with prenatal hydronephrosis. J Urol 168:2153–2157

    Article  CAS  PubMed  Google Scholar 

  54. Rohrschneider WK, Hoffend J, Becker K et al (2000) Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. I. Evaluation of the normal status in an animal model. Pediatr Radiol 30:511–522

    Article  CAS  PubMed  Google Scholar 

  55. Rohrschneider WK, Becker K, Hoffend J et al (2000) Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. II. Findings in experimentally induced ureteric stenosis. Pediatr Radiol 30:523–532

    Article  CAS  PubMed  Google Scholar 

  56. Rohrschneider WK, Haufe S, Wiesel M et al (2002) Functional and morphologic evaluation of congenital urinary tract dilatation by using combined static-dynamic MR urography: findings in kidneys with a single collecting system. Radiology 224:683–694

    Article  PubMed  Google Scholar 

  57. Thoeny HC, Keyzer FD, Oyen RH et al (2005) Diffusion weighted MR imaging of kidneys in healthy volunteers and patients with parenchymal disease: initial experience. Radiology 235:911–917

    Article  PubMed  Google Scholar 

  58. Good CD, Vinnicombe SJ, Minty IL et al (1996) Posterior urethral valves in male infants and newborns: detection with US of the urethra before and during voiding. Radiology 198:387–391

    CAS  PubMed  Google Scholar 

  59. Schöllnast H, Lindbichler F, Riccabona M (2004) Sonographic diagnosis of urethral anomalies in infants: value of perineal sonography. J Ultrasound Med 23:769–776

    Google Scholar 

  60. Teele RL, Share JC (1997) Transperineal sonography in children. AJR 168:1263–1267

    CAS  PubMed  Google Scholar 

  61. Bartram U, Darge K (2005) Harmonic versus conventional ultrasound imaging of the urinary tract in children. Pediatr Radiol 35:655–660

    Article  PubMed  Google Scholar 

  62. Darge K, Heidemeier A (2006) US diagnosis of urinary tract calculi in children using the “twinkling sign”. Ultrasound 14:167–173

    Article  Google Scholar 

  63. Nawfel RP, Judy P, Schleipman R et al (2004) Patient radiation dose at CT Urography and conventional urography. Radiology 232:126–132

    Article  PubMed  Google Scholar 

  64. Smergel E, Greenerg BS, Crisci KL et al (2001) CT-urograms in pediatric patients with ureteral calculi: do adult criteria work? Pediatr Radiol 31:720–723

    Article  CAS  PubMed  Google Scholar 

  65. Strouse PJ, Bates DG, Bloom DA et al (2002) Non-contrast thin-section helical CT of urinary tract calculi in children. Pediatr Radiol 32:326–332

    Article  PubMed  Google Scholar 

  66. Darge K, Casale P (2009) Ureteropelvic junction obstruction in children due to fibroepithelial polyps. ESPR Istanbul. Pediatr Radiol 39:S529 (abstract)

    Article  Google Scholar 

  67. Riccabona M (2007) Lower urinary tract—the ureter and vesicoureteral reflux. In: Slovis TL (ed) Caffey’s pediatric diagnostic imaging, vol 2, 11th edn. Mosby–Elsevier, Philadelphia, pp 2315–2355

    Google Scholar 

  68. Peters CA, Mandell J, Lebowitz RL et al (1989) Congenital obstructed megaureters in early infancy: diagnosis and treatment. J Urol 142:641–645

    CAS  PubMed  Google Scholar 

  69. Wilcox D, Mouriquand P (1998) Management of megaureter in children. Eur Urol 34:73–78

    Article  CAS  PubMed  Google Scholar 

  70. Riccabona M, Sorantin E, Ring E (1998) Application of M-mode sonography to functional evaluation in pediatric patients. Eur Radiol 8:1457–1461

    Article  CAS  PubMed  Google Scholar 

  71. Riccabona M (2009) Urinary tract imaging in infancy. Pediatr Radiol 39:S436–S445

    Article  Google Scholar 

  72. Strehlau J, Winkler P, de la Roche J (1997) The uretero-vesical jet as a functional diagnostic tool in childhood hydronephrosis. Pediatr Nephrol 11:460–467

    Article  CAS  PubMed  Google Scholar 

  73. Avni EF, Matos C, Rypens F et al (1997) Ectopic vaginal insertion of an upper pole ureter: demonstration by special sequences of magnetic resonance imaging. J Urol 158:1931–1932

    Article  CAS  PubMed  Google Scholar 

  74. Avni FE, Nicaise N, Hall M et al (2001) The Role of MR imaging for the assessment of complicated duplex kidneys in children: preliminary report. Pediatr Radiol 31:215–223

    Article  CAS  PubMed  Google Scholar 

  75. Ehammer T, Mayer E, Riccabona M (2010) High resolution MR for the evaluation of lower urogenital tract malformations in infants and children: feasibility and preliminary experiences. Eur J Radiol. doi:10.1016/j.ejrad.2010.01.006

  76. Gylys-Morin VM, Minevich E, Tackett LD et al (2000) Magnetic resonance imaging of the dysplastic renal moiety and ectopic ureter. J Urol 164:2034–2039

    Article  CAS  PubMed  Google Scholar 

  77. Staatz G, Rohrmann D, Nolte-Ernsting CC et al (2001) Magnetic resonance urography in children: evaluation of suspected ureteral ectopia in duplex systems. J Urol 166:2346–2350

    Article  CAS  PubMed  Google Scholar 

  78. Ulchaker J, Ross J, Alexander F et al (1996) The spectrum of ureteropelvic junction obstruction occurring in duplicated collecting systems. J Pediatr Surg 31:1221–1224

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael Riccabona.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Riccabona, M. Obstructive diseases of the urinary tract in children: lessons from the last 15 years. Pediatr Radiol 40, 947–955 (2010). https://doi.org/10.1007/s00247-010-1590-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-010-1590-1

Keywords

Navigation