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Background: Hydronephrosis is the one of the most common congenital abnormalities of urinary tract. The left kidney is more commonly affected than the right side and is more common in males., Aim of the Study: To determine the role of ultrasonography, renal dynamic scintigraphy and lowerdose computed tomography urography in preoperative diagnostic workup of infant with extreme hydronephrosis., Case Report: We presented the boy with antenatally diagnosed hydronephrosis. In serial, postnatal ultrasonography, renal scintigraphy and computed tomography urography we observed slightly declining function in the dilated kidney and increasing pelvic dilatation. Pyeloplasty was performed at the age of four months with good result., Conclusions: Results of ultrasonography and renal dynamic scintigraphy in child with extreme hydronephrosis can be difficult to asses, therefore before the surgical procedure a lower-dose computed tomography urography should be performed.

Introduction of iterative reconstruction technique in modern computed tomography allowed to reduce the radiation dose and to extend indications for computed tomography urography in children. We describe the case of boy with congenital anomalies in urinary tract including bilateral double collecting system, dilatation of double collecting system in the right kidney and dilatation of lower pelvis in left kidney and bilateral dilatation of ureters. Anomalies were detected in prenatal and then confirmed in postnatal ultrasonography. Voiding cystourethrograhy, which was performed on the 4th day of life revealed grade IV vesicoureteral reflux to the lower part of double collecting system in the right kidney and grade V vesicoureteral reflux to the left kidney. In cystoscopy posterior urethral valves were excluded and presence of double ureters was confirmed. Dynamic scintigraphy (99mTc-EC) detected impaired parenchymal secretory function in the lower pole of left kidney. The patient was qualified for surgical treatment including left lower heminephoureterectomy. Before surgery procedure computed tomography urography was performed and revealed congenital anomalies in urinary tract: bilateral double collecting system, bilateral hydronephrosis of the lower part of kidneys, dilatation of ureters associated with high grade of vesicoureteral refluxes, narrow cortex of left kidney. Computed tomography urography with iterative reconstruction techniques enables precise visualization of urinary tracts with reduced radiation dose. It replaces conventional X-ray urography because of much better visualization of urinary tracts with comparable or even lower radiation dose.

Aim: The aim of the study was to assess indications to voiding cystourethrography (VCUG) in children with suspicion of urinary tract (UT) abnormalities in prenatal ultrasonography (US)., Material and Methods: We studied 93 children aged 1 day to 7 months (mean 1.4 +/- 1.3 months). Prenatal USG was done between 18-41 week of gestational age (mean 32.6 +/- 5.6). Congenital anomalies of UT were suspected in 88% fetuses with dilatation of UT and in 12% fetuses with other changes in UT. Postnatal US was done in all children between 1-122 day of life (mean 18.2 +/- 21.5); VCUG between 1 day to 13 months (mean 2.1 +/- 2.3 months), in this in 75 (81%) infants in the first months of life., Results: Abnormal result of postnatal US had 84 (90%) children (dilatation of pyelocalyceal system and/or ureter, duplex kidney, multicystic dysplastic kidney, ureterocele). We found normal VCUG in 67 (72%) children, abnormal in 26 (28%). Vesicoureteral reflux (VUR) to 28 kidneys was detected in 20 (21.5%) children (1st--1 kidney, 2nd--14, 3rd--3, 4th--6 and 5th--4 kidneys); another anomalies in 6 (in 2 posterior urethral valves). VUR was observed in 17.3% VCUG performed before 3 months of age and in 38.9% performed later (p<0.05). VUR was recognized: in 17.2% kidneys with normal prenatal US and in 16.4% kidneys with dilatation of UT (NS); in 6 (8%) kidneys with normal postnatal US and 22 (29.8%) with abnormal (p=0.05). There was not statistically significant difference in frequency of VUR in kidney with normal (0-5 mm) and abnormal postnatal renal pelvic diameter (RPD) (11.3% vs 19%, NS). The sensivity and specifity of normal postnatal USG in detection VUR were 79% and 56% respectively, and of normal postnatal RPD were 61% and 46% respectively., Conclusions: 1. Indication to performing VCUG in children with prenatally detected hydronephrosis should be persistent dilatation of pyelocalyceal system and/or ureter in postnatal US or another abnormalities in UT. 2. Normal prenatal and postnatal USG does not exclude presence of VUR. 3. VCUG in children with prenatally detected hydronephrosis should be performed about 3 months of life, in specially situation earlier.

This study aimed to determine the frequency of associated urological abnormalities in children with unilateral renal agenesis (RA) or multicystic dysplastic kidney (MCDK). In total, 38 children (10 girls, 28 boys) were studied: 21 with RA and 17 with MCDK. In 14 children (37%) anomalies of the urinary tract were suspected prenatally in ultrasound studies. In the remaining 24 children the diagnosis of RA/MCDK was made postnatally: in 13 (34%) in the first 7 days of life, in 11 (29%) at the age of 8 days to 34 months, mean 10.6+/-8.05 months. Voiding cystourethrography was done in 36 (95%) children, the isotopic 99mTc-EC/DMSA scan of the kidney in 29 (67%), and urography in 8. Urological anomalies were present in 11 (29%) children: in 7 (33%) with RA and in 4 (24%) with MCDK. Vesicoureteral reflux was diagnosed in 8 children: grade II in 4, III in 3, and IV in 1 (in 1 child to duplicated, in 1 to ectopic kidney); ureterovesical junction obstruction in 2 (9.5%); and ureteropelvic junction obstruction in 1 (4.8%). Among them, 2 children demanded surgery on the contralateral urinary tract: pyeloplasty in 1, antireflux procedure in 1; while 9 children were treated conservatively. Compensatory hypertrophy of the contralateral kidney was found in 90% of children. Thus due to an increased risk of pathological changes in the single functioning kidney, lifelong nephrological care is recommended in patients with unilateral RA/MCDK.