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Ključevšek D, Ključevšek T. Efficacy of contrast-enhanced percutaneous nephrosonography to evaluate urinary tract patency in children. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:410-415. [PMID: 32542656 DOI: 10.1002/jcu.22883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/02/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
A novel method known as contrast-enhanced percutaneous nephrosonography (cePNS), using an ultrasound contrast agent administered through the nephrostomy catheter, has been used to evaluate the urinary tract patency in children. Nine cePNS examinations were performed in seven children to evaluate the urinary tract patency prior to further management. The cePNS results were compared with the clinical evaluation of patent urinary tract cases or with surgery results. Both, the technical success rate and accuracy of cePNS examinations were 100%. CePNS is a radiation-free method and can be performed as a continuation of an ultrasound examination.
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Affiliation(s)
- Damjana Ključevšek
- Department of Radiology, Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tomaž Ključevšek
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Kohno M, Ogawa T, Kojima Y, Sakoda A, Johnin K, Sugita Y, Nakane A, Noguchi M, Moriya K, Hattori M, Hayashi Y, Kubota M. Pediatric congenital hydronephrosis (ureteropelvic junction obstruction): Medical management guide. Int J Urol 2020; 27:369-376. [PMID: 32162424 DOI: 10.1111/iju.14207] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
Abstract
The prevalence of asymptomatic hydronephrosis, now detected by ultrasonography, has increased. However, definitive management guidelines for the management of congenital hydronephrosis have not been established. The Japanese Society of Pediatric Urology created a "medical management guide" based on new findings for physicians practicing pediatric urology. We developed a medical management guide focused on congenital hydronephrosis caused by ureteropelvic junction obstruction. This medical management guide consists of the definition, pathophysiology, epidemiology, diagnosis, classification, treatment using a clinical management algorithm of hydronephrosis and the long-term course of the disease. The aim of hydronephrosis management is to determine whether surgery should be carried out to avoid renal dysfunction, as there is a possibility for improvement without intervention. Ultrasonography is essential to make treatment decisions. Management is determined by a comprehensive assessment, including the degree of hydronephrosis, anterior-posterior diameter of the renal pelvis and, if necessary, a nuclear medicine evaluation of the status of urine drainage and renal function.
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Affiliation(s)
- Miyuki Kohno
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Tetsushi Ogawa
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatrics, Toranomon Hospital, Tokyo, Japan
| | - Yoshiyuki Kojima
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akiko Sakoda
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuyoshi Johnin
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshifumi Sugita
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Akihiro Nakane
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Mitsuru Noguchi
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Urology, Saga Medical School Faculty of Medicine, Saga University, Saga, Japan
| | - Kimihiko Moriya
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Motoshi Hattori
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yutaro Hayashi
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Masayuki Kubota
- Committee for the Formulation of Medical Management Guide for Pediatric Congenital Hydronephrosis (ureteropelvic junction obstruction), Academic Committee, Japanese Society of Pediatric Urology, Osaka, Japan.,Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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3
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Brandoni A, Torres AM. Renal Expression and Urinary Excretion of Na-K-2Cl Cotransporter in Obstructive Nephropathy. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7171928. [PMID: 28164127 PMCID: PMC5259608 DOI: 10.1155/2017/7171928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/15/2016] [Accepted: 12/12/2016] [Indexed: 01/10/2023]
Abstract
Renal damage due to urinary tract obstruction accounts for up to 30% of acute kidney injury in paediatrics and adults. Bilateral ureteral obstruction (BUO) is associated with polyuria and reduced urinary concentrating capacity. We investigated the renal handling of water and electrolytes together with the renal expression and the urinary excretion of the Na-K-Cl cotransporter (NKCC2) after 1 (BUO-1), 2 (BUO-2), and 7 (BUO-7) days of release of BUO. Immunoblotting and immunohistochemical studies showed that NKCC2 expression was upregulated in apical membranes both from BUO-2 and from BUO-7 rats. The apical membrane expression, where NKCC2 is functional, may be sufficient to normalize water, potassium, sodium, and osmolytes tubular handling. NKCC2 abundance in homogenates and mRNA levels of NKCC2 was significantly decreased in almost all groups suggesting a decrease in the synthesis of the transporter. Urinary excretion of NKCC2 was increased in BUO-7 groups. These data suggest that the upregulation in the expression of NKCC2 in apical membranes during the postobstructive phase of BUO could contribute to improving the excretion of sodium and consequently also the excretion of potassium, osmolytes, and water. Moreover, the increase in urinary excretion of NKCC2 in BUO-7 group could be a potential additional biomarker of renal function recovery.
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Affiliation(s)
- Anabel Brandoni
- Farmacología, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, CONICET, Santa Fe, Argentina
| | - Adriana M. Torres
- Farmacología, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, CONICET, Santa Fe, Argentina
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Bleve C, Conighi ML, Fasoli L, Bucci V, Battaglino F, Chiarenza SF. Proximal ureteral atresia, a rare congenital anomaly-incidental finding: a case report. Transl Pediatr 2017; 6:67-71. [PMID: 28164035 PMCID: PMC5253269 DOI: 10.21037/tp.2017.01.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Ureteral atresia is a rare disease usually associated with a non-functioning dysplastic kidney. The condition may be unilateral or bilateral; focal, short or long and may involve any part of the ureter. Association with other urinary anomalies is rare. We report the case of a 10-month-old boy with prenatal diagnosis of multicystic right kidney. This suspicion was confirmed after birth by ultrasound and static scintigraphy; a right vesicoureteral reflux (VUR) was recorded at cystography. The boy presented a regular renal function but was hospitalized twice for suspected pyelonephritis between the 8th and the 10th month of life and were recorded occasional mild changes in blood pressure. Antibiotic prophylaxis was administered until surgery. When he was 10-month underwent retroperitoneoscopy to perform a nephroureterectomy finding a complete atresia of the upper third of the ureter with the blind end at the level of the uretero-pelvic-junction. The programmed surgery was performed. By a revision of literature, only few cases of imperforate distal ureter have been described. This condition is associated with a kidney dysplasia. The atresia of the ureter with no signs of infection in the dysplastic kidney may be unknown up to adulthood or throughout one's life. Prognosis usually depends on the severity of the obstruction.
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Affiliation(s)
- Cosimo Bleve
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Maria Luisa Conighi
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Lorella Fasoli
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Valeria Bucci
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Battaglino
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
| | - Salvatore Fabio Chiarenza
- Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, Vicenza, Italy
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Bagnara V, Castorina S, Nappo SG, Privitera G, Luca T, Caione P. Hypothesis on etiopathogenesis, congenital or acquired, of an imperforate distal ureter: a case report. J Med Case Rep 2015; 9:227. [PMID: 26444977 PMCID: PMC4596491 DOI: 10.1186/s13256-015-0711-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 09/15/2015] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Ureteral atresia is a rare disease usually associated with a non-functioning kidney. Its association with other urinary anomalies is rare. CASE PRESENTATION In this study we discuss the possibility of congenital or acquired etiology of a right imperforate distal ureter. Here we report the case of 11-month-old white boy with a right ureteropelvic junction obstruction. He underwent a right pyeloplasty when he was 11-months old, and 3 weeks after surgery a cystoscopy was performed. Two months after the first operation, he underwent a right ureteral meatoplasty and a new pyeloplasty. CONCLUSIONS To the best of our knowledge, few cases of imperforate distal ureter have been described in the literature. The suspicion of a non-patent terminal ureter, occurring during upper urinary tract surgery, must be intraoperatively clarified to preserve the renal function and to avoid more complex surgical approaches.
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Affiliation(s)
- Vincenzo Bagnara
- Department of Maternal and Infant Medicine and Radiological Sciences, University of Catania, Via S. Sofia, 78, 95123, Catania, Italy. .,"G.B. Morgagni" Mediterranean Foundation, 95125, Catania, Italy.
| | - S Castorina
- "G.B. Morgagni" Mediterranean Foundation, 95125, Catania, Italy. .,Department of Biomedical and Biotechnological Sciences, University of Catania, 95125, Catania, Italy.
| | - S Gerocarni Nappo
- Division of Urology-Andrology, Department of Paediatric Nephrology-Urology, "Bambino Gesu" Children's Hospital, Research Institute, Rome, Italy.
| | - G Privitera
- "G.B. Morgagni" Mediterranean Foundation, 95125, Catania, Italy.
| | - T Luca
- "G.B. Morgagni" Mediterranean Foundation, 95125, Catania, Italy.
| | - P Caione
- Division of Urology-Andrology, Department of Paediatric Nephrology-Urology, "Bambino Gesu" Children's Hospital, Research Institute, Rome, Italy.
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Kajbafzadeh AM, Mehdizadeh M, Aryan Z, Ebadi M, Esfahani SA, Montaser-Kouhsari L, Elmi A, Talab SS, Sadeghi Z. Drainage-related ultrasonography (DRUS): a novel technique for discriminating obstructive and nonobstructive hydroureters in children. J Ultrasound 2015; 18:117-25. [PMID: 26191099 DOI: 10.1007/s40477-014-0128-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Despite advances in urologic imaging, the paucity of an optimal technique that accurately clarifies obstructive and nonobstructive hydroureter exists. OBJECTIVE This study was conducted to introduce a novel and modified ultrasonographic technique, known as drainage-related ultrasonography (DRUS), discriminating obstructive and nonobstructive, nonrefluxing hydroureter. MATERIALS AND METHODS A total of 358 children (mean age, 3.7 years) with 418 nonrefluxing hydroureter were included. These children were composed of two groups of obstructive nonrefluxing (141 children with 157 dilated ureters) and nonobstructive, nonrefluxing (217 children with 261 hydroureter). The definite diagnosis regarding the subtype of hydroureter was derived from appropriate investigation. The maximum diameter of the dilated ureter, which was observed on ultrasonography, was recorded before and after 3 h of catheterization, as D1 and D2, respectively. To assess the D ratio, a formula was developed, that is, [(|D1 - D2|)/D1] × 100. Values were recorded and cutoff points were set to discriminate between subtypes. RESULTS Obstructive versus nonobstructive subtypes of nonrefluxing hydroureter were clarified with 78.5 % sensitivity and 83.4 % specificity, by setting a cutoff point of 22 % for the D ratio. Regardless of the cutoff point assigned to the reduction in D (D2 compared with D1), DRUS revealed 93.9 % sensitivity, 80.6 % specificity, 63.2 % positive predictive value, and 97.4 % negative predictive value in discriminating upper from lower obstruction. CONCLUSION DRUS affords favorable results in terms of differentiating between obstructive and nonobstructive, nonrefluxing hydroureter, as well as between upper and lower obstruction in obstructive cases. It has the potential to become an efficient imaging modality in the diagnostic algorithm of hydroureter.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Mehrzad Mehdizadeh
- Pediatric Radiology Department, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Aryan
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Maryam Ebadi
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Shadi Abdar Esfahani
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA USA
| | - Laleh Montaser-Kouhsari
- Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, No. 32, 2nd Floor, 7th Street Saadat-Abad Ave, Tehran, 1998714616 Iran
| | - Azadeh Elmi
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114 USA
| | - Saman Shafaat Talab
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114 USA
| | - Zhina Sadeghi
- Department of Urology, University Hospitals of Case Medical Center, Case Western Reserve University, Cleveland, OH 44106 USA
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Epelman M, Daneman A, Donnelly LF, Averill LW, Chauvin NA. Neonatal Imaging Evaluation of Common Prenatally Diagnosed Genitourinary Abnormalities. Semin Ultrasound CT MR 2014; 35:528-54. [DOI: 10.1053/j.sult.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Bianchi D, Vespasiani G, Bove P. Acute kidney injury due to bilateral ureteral obstruction in children. World J Nephrol 2014; 3:182-192. [PMID: 25374811 PMCID: PMC4220350 DOI: 10.5527/wjn.v3.i4.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/28/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Bilateral ureteral obstruction in children is a rare condition arising from several medical or surgical pictures. It needs to be promptly suspected in order to attempt a quick renal function recovery. In this paper we concentrated on uncommon causes of obstruction, with the aim of giving a summary of such multiple, rare and heterogeneous conditions joint together by the common denominator of sudden bilateral ureteral obstruction, difficult to be suspected at times. Conversely, typical and well-known diseases have been just run over. We considered pediatric cases of ureteral obstruction presenting as bilateral, along with some cases which truly appeared as single-sided, because of their potential bilateral presentation. We performed a review of the literature by a search on PubMed, CrossRef Metadata Search, internet and reference lists of single articles updated to May 2014, with no time limits in the past. Given that we deal with rare conditions, we decided to include also papers in non-English languages, published with an English abstract. For the sake of clearness, we divided our research results into 8 categories: (1) urolithiasis; (2) congenital urinary tract malformations; (3) immuno-rheumatologic causes of ureteral obstruction; (4) ureteral localization of infections; (5) other systemic infective causes of ureteral obstructions; (6) neoplastic intrinsic ureteral obstructions; (7) extrinsic ureteral obstructions; and (8) iatrogenic trigonal obstruction or inflammation. Of course, different pathogenic mechanisms underlay those clinical pictures, partly well-known and partly not completely understood.
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Ultrasound of the paediatric urogenital tract. Eur J Radiol 2014; 83:1538-48. [DOI: 10.1016/j.ejrad.2014.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/07/2014] [Indexed: 02/04/2023]
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A case of complete renal duplex with h-shaped ureter. Case Rep Urol 2012; 2012:643207. [PMID: 22754706 PMCID: PMC3384916 DOI: 10.1155/2012/643207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/26/2012] [Indexed: 12/31/2022] Open
Abstract
We present a case of complete renal duplex with H-shaped double ureter opening into the bladder with 2 separate orifices. It is an extremely rare variety of renal duplex which was reported only once in the literature. Fifty-four-year-old male presented to our department with right renal pain. Noncontrast CT revealed stone midthird right ureter with duplex right kidney. Retrograde ureteropyelography and ureteroscopy revealed this rare anomaly.
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Thambidorai CR, Anuar Z. Magnetic resonance urography in duplex kidney with ectopic ureteral insertion. J Indian Assoc Pediatr Surg 2011; 16:115-7. [PMID: 21897576 PMCID: PMC3160054 DOI: 10.4103/0971-9261.83500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is a report on the use of magnetic resonance urography (MRU) in a 6-year-old girl who presented with urinary incontinence. She had a left duplex kidney with poorly functioning upper moiety and ectopic insertion of the dilated upper pole ureter. MRU has been shown to be superior to conventional imaging techniques in delineating poorly functioning moieties of duplex kidneys and ectopic ureters.
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12
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Pilhatsch A, Riccabona M. Role and potential of modern ultrasound in pediatric abdominal imaging. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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