In this work a study of 71 diiated non-refluxing
renoureteral units in 53 patients has been performed.
Patients having reflux, shown by ascending cystography, were
not included in this work.
All the cases presented with I.V.U.s showing dilated
upper urinary tracts. According to the I.V.U., obstruction
has been suggested at the lower end of the ureter in 56
units, at the P.U.J. in 11 units, at the level of sacroiliac
joint in two systems and in lumber ureter in two systems.
All the patients have past history of urological
operations except three patients.
Ascending cystography excluded the presence of reflux
in all the 71 units.
The aim of studYing these cases was to determine
these in which dilatation is due to obstruction and in need
for surgery or these in which obstruction is not present and
no need for surgery.
The diagnostic work up of these cases was:
II) Detailed history taking,
(2) clinical examination,
(3) laboratory investigations,
(4) retrograde pyeloureterography,
------ l-
I
(251)
IS) diuresis renography.
In retrograde studies, assessment of the dilated systernswas
done taking into consideration:
la) passage of the catheter up.
lb) emptying of the injected contrast after removal of
ureteric catheter.
Accordingly, only 13 units allowed the upward passage
of ureteric catheter and emptied the injected contrast and
thus could be considered non-obstructed. In the remaining
l8units lout of 31).a
15
jected contrast ~ ~
catheter could be 'ke
not emptied in
passed but the in-
3 units and the
catheter could not be passed in the other 15 units.
Diuresis renography was performed in 71 dilated renal
units.
The results of diuresis renography were classified
into:
(a) Normal response: spontaneous rapid decline in the activity
lresponse I).
lb) obstructed response: progressive accumulation in the activity
and flat response without significant washout
after furosemide administration (response II).
lc) Dilated non-obstructed pattern progressive accumulation
of activity and prompt complete washout after furosemide
administration (response IlIa).
ld) Equivocal pattern: progressive accumulation of the ac(
252)
tivity and only slow incomplete elimination of the
tracer (response IIIb).
According to these criteria normal response is
present in 8 units and dilated non obstructed response is
present in 38 units i.e. collecting obstruction is excluded
in 46 renal units. Obstructed response is present in 19
renal units and equivocal response in 6 renal units.
Comparison of the results of retrograde studies versus
the results of diuresis renography has shown that:
(a) when retrograde studies suggested that we have a non
obstructed system this was correct in 84.6%.
(b) If the catheter could not passed or the dye was not
evacuated. True obstruction was present in 33.3% of
cases only.
Surgical
renography to be
present in 10
formed.
exploration
obstructed
cases and
of 11 units proved by diuresis
showed true obstruction was
reconstructive surgery was per-
So, the following conclusions can be got out of this
work:
(1) Dilatation may be present without obstruction.
(2) Diuresis renography presents a new, simple, rapid,
physiological, non invasive modality that can be used to
screen all patients with suspected obstruction of the
upper urinary tract.
(253)
A flow-chart for diagnosis of obstruction in dilated
upper urinary tracts has been suggested. |
