Intermittent Hydronephrosis Secondary to Ureteropelvic Junction Obstruction: Clinical and Imaging Features
- 1 January 2006
- journal article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 117 (1), 139-146
- https://doi.org/10.1542/peds.2005-0583
Abstract
OBJECTIVE. We sought to assess the clinical and imaging findings in intermittent hydronephrosis secondary to ureteropelvic junction obstruction, with particular emphasis on the characteristic ultrasonographic findings.METHODS. This prospective, longitudinal, observational study included all children who had intermittent ureteropelvic junction obstruction and presented with abdominal pain over 6 years. Renal ultrasound was used as an initial screening tool to detect intermittent hydronephrosis. Renal ultrasonography was repeated every 1 to 2 days to record serial changes from the symptomatic to the asymptomatic stage. Their clinical manifestations and imaging findings were studied.RESULTS. Eighteen patients (14 boys, 4 girls) were studied. Most had sharp pain that began acutely and typically lasted for <2 days. Most of the children (16 of 18) had nausea and vomiting that accompanied the pain. The acute episode generally resolved spontaneously and was followed by a pain-free interval that ranged from days to months. Factors that predisposed to an attack included increased water intake, vigorous exercise, or bladder distention. All patients had clearly demonstrable obstruction of the renal pelvis during an acute attack, a finding that diminished or resolved during the symptom-free intervals. During convalescence, all patients had renal pelvic wall thickening on ultrasonography. This finding appeared on the second or third day after a painful episode subsided, persisted for 6 to 9 days, and then disappeared in the symptom-free stage. Pyeloplasty was performed in 17 patients, none of whom had recurrent pain on follow-up. Extrinsic obstructions were found in 9 patients.CONCLUSIONS. The keys to diagnosis are awareness of the syndrome, a detailed history, and immediate and serial imaging studies during painful crises. A thickened renal pelvic wall during convalescence is an important ultrasonic sign of intermittent hydronephrosis.This publication has 25 references indexed in Scilit:
- Significance of thickening of the wall of the renal collecting system in children: an ultrasound studyPediatric Radiology, 1999
- The diagnosis of upper urinary tract obstructionBJU International, 1999
- THE PATHOPHYSIOLOGY OF UPJ OBSTRUCTION: Current ConceptsUrologic Clinics of North America, 1998
- The sonographically thickened wall of the upper urinary tract system: correlation with other imaging methodsPediatric Radiology, 1997
- Sonographically demonstrated thickening of the renal pelvis in childrenPediatric Radiology, 1992
- Diuretic Ultrasound. A Non‐invasive Technique for the Assessment of Upper Tract ObstructionBJU International, 1990
- Effect of Bladder Filling on Upper Tract Urodynamics in ManBJU International, 1990
- Relationship between Intermittent Hydronephrosis and MegacalicosisBJU International, 1989
- Unilateral ureteral obstruction. A caue of reversible high renin content hypertensionJAMA, 1973
- Hydronephrosis in children a clinical study of seventy-eight cases with special reference to the role of aberrant renal vessels and the results of conservative operationsBritish Journal of Surgery, 1953