Congenital obstructive uropathy – Diagnostics for optimal treatment

Abstract

Antenatal ultrasound screening techniques reveal urological abnormalities in about 1 of 500 cases with half of which belonging to hydronephrosis. Postnatal appropriate diagnostic modalities are obligatory for proper diagnosis. Nowadays, ultrasound is definitively one of the most useful imaging modalities for the upper tract in children with hydronephrosis. It is non-invasive, radiation free and can be repeated. In addition, ultrasound also offers excellent images of the lower urinary tract in the diagnosis of posterior urethral valves or  ureteroceles for example. An additional tool is isotope renal scintigraphy which is method to analyse   differential renal function and drainage of the kidney as well as functioning cortical mass with an accurate image of renal parenchyma. Today MRI studies are  becoming more and more popular. This technique is  particularly suited to urological imaging, because of its excellent delineation of water/urine-containing   structures. The micturating cystourethrogram is still the gold standard in imaging the bladder and the urethra. It also serves as a functional investigation while the patient is voiding. The technique consists of catheterizing the person in order to fill the bladder with a radiocontrast agent and is, therefore, an invasive method. Since there is a risk of an increase in severity and functional deterioration with time on the one hand but also  improvement and stable function on the other hand, suitable diagnosis is mandatory in order to rule out the children at risk.