Pope J C, Showalter P R, Milam D F, Brock J W
Division of Pediatric Urology, Children's Hospital of Vanderbilt University Medical Center, Nashville, Tennessee.
Urology. 1994 Oct;44(4):565-71. doi: 10.1016/s0090-4295(94)80061-8.
The diagnosis of urinary obstruction in newborns and infants remains difficult because the diagnostic studies available at present are fraught with many problems. It is our premise that precise measurement of renal pelvic pressures under physiologic conditions in patients with urinary tract dilation will allow diagnosis of obstruction and prediction of further renal damage. This study evaluates an intrapelvic pressure monitoring system.
Four porcine subjects had partial ureteropelvic junction obstruction created surgically; two subjects were used as controls. Doppler ultrasound and MAG-3 furosemide renography were performed preoperatively and each week pressures were measured with a Millar 5 F solid-state pressure transducer and the analog signals were converted on line to digital information to allow signal processing and later data analysis. Antegrade nephrostograms were obtained at the same sitting and showed that the model remained stable over time. Measurements were obtained at physiologic flow rates as well as at the standard Whitaker infusion rate of 10 cc/min.
Thirteen pressure studies were performed on 9 kidneys. Each study was classified as normal (4), partial obstruction (8), or total obstruction (1), based on ultrasound and nephrostogram criteria. The normal units had baseline pressures of 4.12 +/- 0.94 cm water (H2O), which increased to 9.12 +/- 1.38 cm H2O with infusion. In the partially obstructed group, baseline was 16.4 +/- 3.83 cm H2O and increased to 35.3 +/- 15.9 cm H2O with infusion. The kidney with total obstruction showed a baseline pressure of 27 cm H2O, which increased to 68 cm H2O with infusion. These pressure measurements were also compared to furosemide renography.
Intrapelvic pressures correlated well with conventional ultrasound and nephrostogram in the evaluation of partial obstruction. However, the results of furosemide renography and the Whitaker test were quite variable and did not accurately define partial obstruction or correlate with intrapelvic pressure. The Millar solid-state transducer monitoring system is an accurate method of evaluating the intrapelvic pressure and could possibly become a standard for diagnosing significant urinary obstruction against which other studies can be evaluated.
