Postnatal approach to UPJ-O like ANH

• 03 Jan 2020 06:19:38 PM
• |Pediatic Urology

Attaching PDF file of Prof. Venugopal on this subject

Comments(4)

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  Dr. Anil Takvani

  03 Jan 2020 06:21:04 PM

  Trying again

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  Dr. Anil Takvani

  03 Jan 2020 06:22:40 PM

  Attache two more write up of Prof. Venugopal on this subject

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  Dr. Anil Takvani

  06 Jan 2020 08:53:40 PM

  Posting write sent from Prof. S S Joshi Sir; I would like to summarise what Prof. Venugopal has said in three articles he has researched. For diagnosis, treatment and prognosis in pelviureteric obstruction, we have to rely on 1. Clinical examination and history or else you are likely to miss the failure to thrive, palpable kidney, tender kidney etc. 2. For detailed studies of pathological anatomy we have ultrasound examination. Venu has described many parameters and ultrasound based classification. To me it is confusing as to which is the best of the lot. SFU classification was one of the first to be established and is extremely popular. Onen's classification is an improvement , but in India I think SFU is more popular and I would recommend it so that we can understand what our colleague is saying. 3. For degree of obstruction and relative differential function we have renograms. Problem with USG are the sonologists. They are always in a hurry -. Like Anil I send all my paediatric urology patients to only three sonologist in Mumbai. These are the ones who have time and after getting after them time and again willl , look at all the parameters on USG. So if you send your work to a sonologist and discuss with him all points of USG he will do a good job, but one has to patronise him! On usg parameters I look for are 1. Kidney size and any scars 2. APPD of kidney 3. transverse diameter of the dilated calyces 4. Parenchymal thicknes in mm, 5 clarity of urine in the dilated calyces, should not be hazy or cloudy, 6. any stones , 7. to assess the ureter below the level of ischial spine on fulll bladder. If this is dilated,but upper 1/3 is not, it gives hint that this could be PUJn obstruction with VUR. This will allow you measure two very good prognostic parameters viz. Pelvis- parenchyma ratio (Babu et al) and Dilated calyx to parenchyma ( opposite to measured calyx ) ratio ( Dewan et al) The number of sonologist available in India far out number nuclear medicine centres, It is therefore, imperative that we hone our skills on usg for diagnosis and prognosis. There is no one test that will give diagnosis of obstruction, or will tell you which child needs surgery or conservative treatment. You have to do clinical, usg, and renal scan to come to conclusion Radio nuclide studies are important. I don't know why we continue to use DTPA scan for obstruction instead of switching over to Tch-EC scan. If MAG 3 is better that DTPA for obstruction, then TchEC is equivalent to MAG 3. and importantly it is made my BARC in India, readily available and cheaper than MAG 3. The only protocol we follow at Jaslok is F-0 . Although Venu has described all the important parameters including their short comings, I would like to stress the importance of Cortical Transit time. We have been using it in Jaslok for last >6 years and find it very useful in borderline cases. It is now the part of our soft ware. I am sure Venu and others will find faults and would like punch holes in my summary, they are most welcome and it would interesting debate. SSJ

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  Dr. Anil Takvani

  07 Jan 2020 09:28:15 AM

  Dear Gyanendra, I am attaching this file of yours on CTT from my mobile... Thanks

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