Antegrade Pyelography

WiCKBOM was the first to describe percutaneous diagnostic antegrade pyelography in 1954. Percutaneous needle nephrostomy to relieve obstruction was subsequently described by Goodwin et al. (1955). Stables et al. (1978) later demonstrated the very low complication rate of this procedure and established it as the treatment of choice for the emergency relief of renal obstruction. 

Fig. 1.1.10. Antegrade pyelography combined with the Whitaker test on general anesthesia in a 6-month-old baby. No reflux. Slight dilatation on ultrasound and IVU. Diuresis renography had not been conclusive, and the Whitaker test showed obstruction at the ureteropelvic junction. Surgery was subsequently performed...

Fig. 1.1.11. Antegrade pyelography combined with the Whitaker test. Patient is in the prone position on general anesthesia. A Foley catheter is placed in the bladder and pressure is monitored. Two needles are placed in the renal pelvis with sonographic guidance. One is used to infuse contrast medium on either constant pressure perfusion or constant flow perfusion. The other one is connected with a pressure transducer. (Drawing by V. Genne, MD)...

Fig. 1.1. 12. Antegrade pyelography combined with the Whitaker test. Intermittent obstruction at the ureteropelvic junction in a child with equivocal results on diuresis renography. Constant flow renal perfusion (5 cc/min). Transient peak in pelvic and differential pressures are shown and complete the criteria for obstruction...

In rare instances, obstruction caused by a fungus ball may be treated with a combination of percutaneous nephrostomy and infusion of amphotericin (Fig. 26.3) (Matsumoto et al. 1990). In asymptomatic children with hydronephrosis, antegrade pyelography and pressure measurement (Whitaker test) maybe performed prior to surgical or endouro-logic correction to document the level and nature of the obstruction. Finally, percutaneous nephrostomy... 

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