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American Journal of Roentgenology, Vol 158, 837-842, Copyright © 1992 by American Roentgen Ray Society

ARTICLES

The ureterovesical junction in children: sonographic findings after surgical or endoscopic treatment

F Rypens, EF Avni, WO Bank, CC Schulman and J Struyven
Department of Radiology, Hopital Erasme, Universite Libre de Bruxelles, Belgium.

We retrospectively analyzed pre- and postoperative sonographic and medical records of 335 children who had surgical or endoscopic treatment at the ureterovesical junction, in order to determine normal and atypical sonographic appearances. Normal sonographic findings after ureteral reimplantation include thickening of the posterior bladder wall, pseudodiverticular sacculations, bladder asymmetry, and transitory hydroureteronephrosis. Short-term or persistent (lasting more than 1 month) hydroureteronephrosis, urinoma, hematoma, bladder lithiasis, and diverticula were abnormal findings, occurring in 17% of the patients. After partial ureteronephrectomies, visualization of the residual ureter on sonograms was not possible in cases without complications; in one patient, reflux of fluid dilated the residual ureter and made the ureter visible on sonograms. After endoscopic incisions, the masslike appearance of a collapsed ureterocele was observed. Submucosally injected Teflon always appeared as a curvilinear hyperechoic area with an acoustic shadow. Marked acute or persistent hydroureteronephrosis or ectopic intracavitary Teflon particles were observed in 2% of patients. Granuloma formation was considered likely in 5% of the patients when the area of injected Teflon material was longer than 12 mm on sonograms. Submucosally injected collagen appeared less echogenic than Teflon and showed no acoustic shadowing. The various normal sonographic appearances after treatment must be known in order to distinguish them from significant abnormalities. In patients with anatomic anomalies, such as short-term or persistent hydroureteronephrosis, urinoma, hematoma, and lithiasis, complementary uroradiologic examinations may be necessary to clarify the diagnosis.
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H. J. Paltiel, D. A. Diamond, D. Zurakowski, L. A. Drubach, and A. Atala
Endoscopic Treatment of Vesicoureteral Reflux with Autologous Chondrocytes: Postoperative Sonographic Features
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