Is retrograde pyelography necessary prior to pyeloplasty?

Moneer K. Hanna, Jeffrey A. Stock

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The importance of opaclflcation of the ureter by contrast study distal to the ureteropelvic junction (UPJ) prior to pyeloplasty for obstruction is controversial. Some surgeons believe it is important, others do not. We reviewed the records of 215 children, who had undergone retrograde pyelograpby and pyeloplasty. The ureter was visualized in all but two. 21 children were referred for redo-pyeloplasty, for persistent obstruction following open pyeloplasty or endopyelotomy. Additional Information was gained by retrograde pyelography in 18 patients. Therefore 18/192 (9.3%) benefited from tie study. These included: long segment of UPJ narrowing (>2cm) in 6 patients, multiple ureteral strictures at different levels of the ureter in 5, mid-ureteral stricture in 5 and unsuspected complete ureteral duplication in 2 patients. The latter cases (7) could not have corrected adequately through a posterior lumbotomy Incision, which is our favorite exposure for routine repair of UPJ Obstruction. In 9 cases the surgical plan was changed by the new information. These included modified pyeloplasties and judicious use of Double J ureteral slents. In two cases with diffuse stricture the surgery was canceled and were subsequently treated with endopyelolomy. This review showed that retrograde pyelography is not necessary for routine pyeloplasty, performed through an anterior subcostal or flank incision. However, if one adopts a lumbotomy exposure, visualization of the ureter distal to the UPJ is recommended to avoid any 'unpleasant surprises', which may be encountered in 6.7% of cases. As for redo-pyeloplasty, visualizaUon of the whole system by combined antegrade & retrograde pyelography is essential.

Original languageEnglish
Pages (from-to)298
Number of pages1
JournalBritish Journal of Urology
Issue numberSUPPL. 2
StatePublished - 1997
Externally publishedYes


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