Whitaker Test and its Utility

Dear All,

Whitaker in 1973 introduced Ante Grade Pressure Measurement for detection of Upper Tract Obstructions notably PUJ Obstructions. Though many subsequently considered an inflow of 10mL/ minute as unphysiological and hence may not have a place in assessing obstructions. There are studies where inflow is reduced to 2mL/min which they believe is more physiological.

The problem arises as there are some who state that even Renograms as practiced today have their limitations in detecting Obstructions and they are not foolproof.

Are there any indications for performing ‘Whitaker’s Test’ in Modern Urology or this test should now be relegated to history.

Opinion of members are invited so that we can have a fair say on whether Whitaker’s test have any place in Modern Paediatric Urology




  • Gyanendra Sharma
    Gyanendra Sharma
    02 Mar 2021 06:06:38 AM

    Whitaker Test, introduced in 1973 was long considered to be a gold standard to diagnose obstruction in a dilated pelvicalyceal system

    It is an invasive test which is rarely done nowadays
    With the advent of Diuretic renogram in 1984(as described by O ' Reilly et al) obstruction increasingly got diagnosed using the washout curves  and T1/2 values
    But increasingly investigators feel that drainage curves are not indicators of obstruction and T 1/2 values > 20 minutes do not necessarily mean that the system is obstructed.
    Though all would agree that a non obstructed pattern of drainage curve and T 1/2  less then 10minutes rules out obstruction, the diagnosis of obstruction is less clear
    This brings forth the most pertinent question--How do we define obstruction
    The most logical answer to this would be-- any impediment to the flow of urine of urine which leads to deterioration of renal function is Obstruction
    With the diagnosis of hydronephrosis in prenatal period often we come acrosss children where the function is preserved but there is significant dilatation of the pelvi calyceal system
    Renogram in many such cases show drainage curves  and T 1/2 values which are not accepted by many as indicative of obstruction
    So  should Whitaker test be used in such cases?
    I personally feel that in the present era this test is not needed
    Many other parameters like Cortical transit time and regular follow up with sonography give a very good idea regarding the possibility of the function deteriorating in future
    I personally never look at the drainage curves & T 1/2 values to diagnose obstruction
    Very interestingly Whitaker test has been compared with Cortical transit time in studies done in 1977 & in 1979 by Whitefield  & Britton  respectively and they found very good correlation between the two
    In the present era obstruction can be diagnosed without using Whitaker test using  Cortical transit time , NORA --on renogram--and in equivocal cases by  regular follow up with sonography & repeat renogram

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