Interventional uroradiologic procedures in children

Interventional radiologists and urologists have worked together over the past decades to treat diseases of the urinary tract in children. Since congenital upper tract dilation most commonly presents in the first months of life and adult-sized cystoscopes and ureteral catheters were too large for treating small pediatric patients, percutaneous nephrostomy was the only minimally invasive way to access the kidney and ureter for many years. As devices have grown smaller, retrograde techniques to access the infant bladder and ureter have become mainstays of pediatric urologic practice. Although placement of ureteral stents from below is now routine, percutaneous access to the kidney and ureter remains helpful in the postoperative or transplanted bladder, where access from above allows placement of antegrade ureteral or nephroureteral stents which can be difficult to place from below. In addition, percutaneous techniques can be used to biopsy, drain, dilate, or stent many other urologic conditions in children including postoperative complications such as urinoma or infection. In this chapter, we will review the available imaging modalities for the urologist and radiologist with emphasis on radiation dose and safety and then discuss the common interventional procedures performed on the pediatric urinary tract.