Attaching PDF file of Prof. Venugopal on this subject
Attache two more write up of Prof. Venugopal on this subject
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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
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
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
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.
I am attaching this file of yours on CTT from my mobile... Thanks