Kalabhavi Srinivas K.pdf

Proforma
A nuclear scan is also of value in predicting recoverability of function in those
cases in which IVP has revealed non-visualization. In this setting, a 99mTc-DTPA
scan can help predict recoverability of function, because essentially all kidneys that
function on such scans will improve following relief of obstruction. DTPA scan will
also be of value in differentiating dilated, non obstructed systems from those with
functional obstruction.
Roake and Sandler (1998) reviewed in detail the role of diuretic renography
for evaluation of UPJO.
5. Invasive tests:
Retrograde pyelography is indicated whenever the UPJO requires acute
decompression such as in setting of infection or compromised renal function. In such
cases, an attempt can be made to pass a floppy tipped guide wire or hydrophilic
“glide” wire, followed by open-ended ureteral catheter or internal stent, to allow
decompression of the system and thus better prepare the patient for reconstruction at
a later date.
In cases in which cystoscopic retrograde manipulation has been unsuccessful
or may be hazardous, such as in male neonates or infants placement of percutaneous
nephrostomy is an excellent alternative. This also allows the performance of
antegrade studies that will help define the nature and exact anatomic site of
obstruction.