PEDIATRIC PYELOPLASTY - IS ROUTINE RETROGRADE PYELOGRAPHY NECESSARY

To evaluate the necessity for retrograde pyelography in the preoperati ve evaluation of children undergoing pyeloplasty, we reviewed the reco rds of 108 consecutive patients (age range 5 days to 18 years, median 1 year) who underwent pyeloplasty at our institution during a 6-year p eriod. The routine preoperative evaluation consisted of a renal/bladde r sonogram, furosemide renal scan ((99m)technetium-diethylenetriaminep entaacetic acid or (99m)technetium-mercaptoacetyltriglycine) and voidi ng cystogram. No other imaging studies were obtained in 95 patients (8 8%). Other upper tract studies usually performed before referral inclu ded excretory urography in 9 cases and computerized tomography in 5. P reoperative retrograde pyelography was only performed in 1 symptomatic patient before referral to our institution. Surgical findings confirm ed obstruction at the ureteropelvic junction in all patients. Undetect ed ureteral dilatation, which might suggest undiagnosed distal obstruc tion, was not encountered. After pyeloplasty 2 patients were lost to f ollowup, renal drainage improved in 104 (98%) and drainage failed to i mprove in 2 of whom 1 (0.9%) required reoperation. All patients who pr esented with symptomatic ureteropelvic junction obstruction experience d postoperative resolution of the presenting complaints. Our series de monstrates that routine retrograde pyelography to define the level of obstruction is not necessary for successful primary pyeloplasty. In ex perienced hands and with careful attention to detail, the combination of renal/bladder sonography and diuretic renography can reliably exclu de the possibility of distal obstruction in children with hydronephros is before pyeloplasty.