* Laser PUValves fulguration * Neurogenic bladder
Treatment of vesicoureteral reflux:
1. Endoscopic Deflux
2. Robotic & laparoscopic & open ureteric Re-implantation(+/- Tapering)—non-refluxing & refluxing.
* Open, Lap & Robotic pyeloplasty/ Ureterocalycostomy, Ureteric Re-implantation.
In the acute care setting
1) Protocol in diuretic renography furosemide is advisable in the pediatric patients and especially in the acutely-ill patients because it only takes about 20 to 25 minutes to the completion of the study as well as the protocol Better tolerance of patients and less radiation exposure can be expected with this approach.
2) Acute pyelonephritis
Even though renal cortical scintigraphy plays a critical role in detecting renal scar and pyelonephritis, the procedure takes hours, which might be inappropriate in the acute care setting. Doppler ultrasonography has a low sensitivity of detecting acute pyelonephritis, and enhanced CT, despite its high sensitivity, has a risk of complications associated with contrast agents.
Diuretic renal scintigraphy with short protocol adopting simultaneous injection of radio tracer and furosemide can be safely done with less radiation than enhanced CT, in short time, and without the need of sedation in most cases. The typical finding of APN in diuretic renal scintigraphy, presented as regional parenchymal dysfunction, has reliable sensitivity as compared with renal cortical scintigraphy.
3) Urinary leak
The urinary leak can be caused by trauma or can occur as a complication after transplantation (anastomosis site, necrosis of distal ureter of transplant, etc) or as a consequence of iatrogenic injury. If additional information about other organ and/or bony structures is required as in the case of blunt trauma, CT is the modality of choice.
However, in the case of a suspected urinary leak following transplantation or patient allergic to the contrast media, multiple serial images of renal scintigraphy can effectively detect the presence of urinary leak and urinoma. Renal scintigraphy for detection of urinary leak and urinoma, but the study can also be used to differentiate urinoma from lymphocele or seroma.
4)Acute kidney injury
Assuming that there exist various causes (prerenal, intrinsic, postrenal) of acute kidney injury (AKI), identifying most probable insult as early as possible is nevertheless worth emphasizing. In patients with a kidney transplant, early detection of AKI and rapid therapeutic management are essential to minimize the risk of graft loss. Renal scintigraphy can nicely demonstrate renal artery stenosis and infarct as perfusion defect and loss of uptake in the affected area.
Aforementioned scintigraphic findings of renal vein thrombosis can overlap with that of acute rejection. Diuretic renography has an invaluable role in the detection of urinary tract obstruction in the posttransplant patient. If prolonged renal cortical retention of radiotracer with relatively preserved perfusion is noted in renal scintigraphy, acute tubular necrosis (ATN) is suggested.
Decreased perfusion, cortical uptake, and excretion of renal transplant are considered a typical scintigraphic pattern of acute rejection. The scintigraphic evaluation of renal transplant provides functional and anatomical information promptly with the noninvasive procedure and with low radiation dose, so it can be readily chosen as the imaging modality of renal transplant in pediatric patients especially in the acute care setting before another invasive procedure such as needle biopsy is taken.
The relative function of kidneys measured scintigraphically is useful for the evaluation of duplex, dysplastic, ectopic, and small kidney and for assessing remaining function preoperatively. Future prospective Several attempts to develop new and powerful radiopharmaceuticals for functional renal imaging have been underway43).
Among much potential PET (positron emission tomography) tracers targeting the angiotensin II subtype 1 receptor, use of which in human is expected shortly. In infants and children, since congenital obstructive nephropathy may cause renal failure in many cases, detecting obstruction in the molecular level before serious structural and functional consequences take place will contribute to the management of these patients.
Evaluation of renal perfusion with O-15 labelled water can be done if on-site cyclotron is available for the production 46). Rubidium-82 chloride (82Rb) PET is recently suggested as a potential renal imaging agent47).
The development of novel molecular imaging tracers with better performance for the diagnosis and management of urologic disease, which can be used safely and reliably in clinical routine, also in the pediatric population, is eagerly anticipated.