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June 1981

Radiological Case of the Month

Author Affiliations

Contributed from the Sections of Pediatric Urology (Dr Wacksman) and Pediatric Nephrology (Dr Kallen), Diagnostic Center for Children and Youth, and the Department of Diagnostic Radiology (Dr Lalli), Cleveland Clinic Foundation.

Am J Dis Child. 1981;135(6):561-562. doi:10.1001/archpedi.1981.02130300061020

A 13-year-old boy was first observed for massive hydronephrosis at the age of 5 years. He had been well until 18 months of age, when he was noted to have a poor voiding stream. Evaluation at that time showed bilateral hydronephrosis, necessitating placement of a permanent suprapubic tube. Increasing renal failure ensued over the subsequent 3½ years, and at the age of 5 years he was referred for further evaluation. A voiding cystogram was obtained (Fig 1). Consistent with marked renal insufficiency (serum creatine level, 2.2 mg/dL), an intravenous urogram (IVU) showed virtual nonvisualization. An exploratory operation was performed, and because of massively dilated ureters, bilateral cutaneous ureterostomies were accomplished. A follow-up IVU showed residual massive caliectasis but obviously improved renal function (Fig 2). Over the next several years the child did relatively well, but gradually increasing signs of renal failure developed. To improve drainage of both kidneys,

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