ARE MODERN IMAGING TECHNIQUES OVER DIAGNOSING URETEROPELVIC JUNCTION OBSTRUCTION

Since the widespread use of real-time ultrasonography in the early 198 0s, ureteropelvic junction obstruction has been diagnosed at earlier a ges and prenatally on a presumptive basis. However, substantial contro versy exists over the diagnosis and treatment of ureteropelvic junctio n obstruction. We conducted an epidemiological study to determine if m odern imaging techniques are leading to the over diagnosis of ureterop elvic junction obstruction. Records were collected retrospectively fro m 3 hospitals serving 2 adjacent counties to determine the number of p yeloplasties performed in 1970 to 1992. The 2 university hospitals and 1 large private hospital provide a wide variety of services and choic e of urologists, and so it was assumed that most patients requiring py eloplasty in the area would be captured. Of the 555 pyeloplasties 240 (43%) were performed on children 12 years old or younger. Logistic reg ression analysis revealed an overall increase of pyeloplasties per yea r of 56.8% in 23 years, which was not markedly different from the popu lation growth in the area in the same period (49.3%). A statistically significant increase in the number of pyeloplasties performed in the f irst year of life was noted. This trend appeared to begin in 1981: 8 p yeloplasties were performed in the first year of life between 1970 and 1980 compared to 91 between 1981 and 1992. Pyeloplasties in children 1 to 6 years old increased with time at a much lower rate that was not statistically significant and the number of pyeloplasties decreased i n those 7 to 12 years old. Therefore, it appears that modern imaging t echniques are not leading to an over diagnosis of ureteropelvic juncti on obstruction but to detection of the disease at an earlier age.