Balloon-like Renal Pelvis 4 (UTI/VUR)

harn_14a_n.jpg: IVU in the same patient as in harn_13a_n.jpg prior to surgery. The work-up examinations were performed due to recurrent abdominal colics of the left side. The pelvicocaliceal system of both kidneys is not dilated, and the calices have a normal configuration. harn_14b_n.jpg: Repeated IVU following an i.v. infusion for fluid load. In contrast to the right kidney in which the maximum contrast excretion has already happened, the left kidney exhibits a dilated pelvicocaliceal system with contrast accumulation and deformed fornices. harn_14c_n.jpg to harn_14e_n.jpg: Operative findings: In the center of the figure there is the dilated renal pelvis; the proximal ureter is marked with a blue restraint and the vessels running over the ureteropelvic junction are retracted loosely by a red string. The three sequences of pictures show a different wideness of the renal pelvis. The clinical and radiological diagnosis of an intermittent obstruction of the ureteropelvic junction may be difficult, and there is the danger that the symptoms are explained as functional. Because the ultrasound as well as the IVU or CT with contrast may be normal in the painless interval, it is necessary to perform the examinations during a pain attack or following a fluid load. The scintigraphy also shows a characteristic tracer excretion. The operative sequences show the changes of the wideness of the renal pelvis already without any fluid load.