Antegrade pyelography before pyeloplasty via dorsal lumbar incision

Purpose: The need for contrast imaging of the ureter before routine pediatr ic pyeloplasty is controversial. We evaluated the use of antegrade pyelogra phy for upper tract imaging before pyeloplasty via dorsal lumbar incision. Materials and Methods: The records of all patients who underwent pyeloplast y from April 1994 through April 1998 at our institution were reviewed. The findings and outcome of patients with presumed ureteropelvic junction obstr uction in whom antegrade pyelography was performed under the same: anesthet ic were assessed, and those in whom this procedure changed the planned oper ative approach were identified. Results: Antegrade pyelography was performed without complication in 72 pat ients before planned pyeloplasty and 2 attempts were unsuccessful. In 10 ca ses (14%) plans for dorsal lumbar incision were abandoned based on findings of renal malrotation in. 3, ureteral stricture in 2, ureterovesical juncti on obstruction in 2, unusually low or high position of the ureteropelvic ju nction in 1 each, and concurrent ureteropelvic and ureterovesical junction obstruction in 1. The study was misinterpreted in 1 case of renal malrotati on and: 1 case of horseshoe kidney, and the dorsal approach was used. In 1 of these cases conversion to an anterior approach was required. A nonobstru cting ureterovesical junction was seen in 2. other patients who had uretero pelvic junction obstruction with mild ureteral dilatation on ultrasound. Conclusions: The dorsal lumbar incision may provide inadequate exposure in certain patients with upper tract obstruction. Antegrade pyelography is a s imple, safe and useful technique to visualize the collecting system before planned pyeloplasty via dorsal lumbar incision, allowing the surgeon to cho ose a more suitable operative approach or procedure when warranted.