The application of retrograde pyelography in the diagnosis of traumatic ureteropelvic junction disruption in children

Abstract

Objective To explore the application of retrograde pyelography with traumatic ureteropelvic junction disruption in children. Methods A retrospective study was conducted for a total of 26 children with doubt of traumatic UPJ disruption in image from 2009 January to 2017 September. There were 19 males and 7 females with a mean age of 5.4 (1-11) years. And the causes were traffic accident (n=15), fall injury (n=4) and fall damage (n=7). Ultrasound and CT examination indicated different degrees of urinary extravasation in all cases. Enhanced CT delayed imaging had no ureteral enhancement, and could not specify whether UPJ was disrupted. All the patients underwent retrograde pyelography through cystoscope under the general anesthesia. If the retrograde tube entered the renal pelvis smoothly, and the ureter and renal were complete, which was considered to be renal injury. If it was difficult for the tube to reach the UPJ, and the ureteral blind end was shown by contrast angiography, UPJ fracture was considered. Results UPJ was not broken in 9 patients (34.6%), and the peritoneal urine was gradually absorbed after conservative treatment. Retrograde pyelography showed no sign of kidney in 16 cases (61.5%). UPJ disrupture was considered and performed renal exploration. These 16 cases were all confirmed as UPJ disrupture during operation. 15 patients underwent ureteropelvic anastomosis, 1 patient underwent ureteral anastomosis by using appendix because of long segment defect, and intravenous pyelography after surgery showed that the ureter was unobstructed. Urinoma but not renal was enhanced in 1 patient (3.9%). One case (3.9%) retrograde pyelography showed the perirenal urinary cyst was enhanced, the kidney was not enhanced, and the possibility of UPJ fracture was considered .But this patient was confirmed UPJ not disrupted in the operation and underwent pyeloplasty. Intravenous pyelography showed no contrast agent extravasation after surgery. The sensitivity and specificity of retrograde pyelography in this group were 100% (16/16) and 90% (9/10), respectively. Conclusions The sensitivity and specificity of retrograde pyelography were higher, and retrograde pyelography was reliable and irreplaceable in the early diagnosis of UPJ disrupture. Key words: Retrograde pyelography; Ureteropelvic junction disruption; Traumatic; Children