모든 신우요관이행부협착 환아에서 배뇨중방광요도조영술은 필요한가?

Abstract

Purpose: Voiding cystourethrography(VCUG) are routinely recommended in order to detect vesicoureteral reflux(VUR) in children with ureteropelvic junction obstruction(UPJO). VUR associated with primary UPJO is usually low grade and resolved spontaneously after pyeloplasty, whereas pseudo-UPJO or UPJO secondary to high grade VUR usually present with dilated ureter that is easily detected by ultrasonography(US). We assessed the role of VCUG in the children with UPJO by retrospective evaluation of the incidence and natural history of VUR associated with UPJO.

Materials and Methods: We reviewed 107 children(<15 years) who underwent pyeloplasty at our hospital between January 1990 and December 1998. The diagnosis of UPJO was based on US and diuretic renography. Preoperative VCUG was performed in all patients to check for VUR. We categorized VUR as non-dilated and dilated VUR.

Results: There were 90 boys and 17 girls in whom 107 pyeloplasties had been done. Mean age at surgery was 27.4 months. Of the 107 patients, 85 had unilateral and 22 had bilateral UPJO. VUR was documented in 21 ureters in 13 children(12.1%). Of the 85 unilateral UPJO, 10 had VUR(bilateral VUR; 6, ipsilateral; 2, contralateral; 2). Of the 22 bilateral UPJO 3 revealed VUR . Of the 13 cases with VUR, 6 had non-dilated and 7 had dilated VUR. All of the non-dilated VUR spontaneously disappeared within an average period of 4.2 months(range 2 to 10 months) after pyeloplasty. Of the 7 dilated VUR 6 underwent ureteroneocystostomy because of persistent VUR after pyeloplasty, and one initially underwent ureteroneocystostomy and subsequently underwent pyeloplasty because of newly developed UPJO. All of the dilated VUR were easily detected by US.

Conclusions: Non-dilated VUR spontaneously disappeared after pyeloplasty. The incidence of dilated VUR was not high, and all dilated VUR were easily detected by US. Therefore we believe that indication of VCUG in children with UPJO might be limited to the cases with dilated ureters.