Abstract
Diagnosis of hydronephrosis, including the intermittent form is difficult. We investigated five patients with ureteropelvic junction obstruction in whom the chief complaint was recurrent intermittent flank pain accompanied by vomiting. All five patients were boys aged between 4 and 7 years in whom the left side was affected. In 4 of 5 patients, the presenting symptoms were intermittent flank pain and vomiting. Only one patient (case 5) complained of abdominal discomfort in addition to intermittent flank pain and vomiting. Ultrasonography performed during the pain attack demonstrated dilatation of the renal pelvis in all patients, and this dilatation was more pronounced during the attackthan during convalescence in 3 of the 5 patients. During convalescence, ultrasonography demonstrated mild dilatation of the renal pelvis in these 3 patients and thickening of the renal pelvis in one patient. Urinalysis showed microscopic hematuria despite normal results of blood examinations. Abdominal X-ray examination performed in 2 of the 5 patients demonstrated deviation of colon gas to the outside because of a mass effect of the dilated pelvis. The cause of ureteropelvic junction obstruction was intrinsic stenosis in one case, fibrous band in one case, ureteral kinking in two cases, and a ureteral polyp in one case. Postoperatively, all patients were relieved of pain. On the basis of our experience, we suggest that abdominal ultrasound examination should be done for children presenting with recurrent intermittent flank pain, microscopic hematuria, and deviation of colon gas to the outside on abdominal X-ray films.
