Abstract
Background
The new technique of percutaneous direct radionuclide cystography (PDRC) allows the accurate demonstration of vesicorenal reflux under physiological conditions during resting and micturition phases. Five types of reflux have been described, the clinical relevance of which is uncertain.
Objective
To determine whether a relationship exists between the type of reflux identified on PDRC and the appearance of the ureteric orifice at cystoscopy or the prevalence of renal abnormalities.
Materials and methods
The reports of 281 PDRC examinations were reviewed and 76 children with reflux formed the population of this study. Studies of these children were reviewed to classify the reflux as types 1–5, and patient records were searched for cystoscopy and DMSA scan reports.
Results
Regardless of the type of reflux, the ureteric orifices were found to be open at cystoscopy in 60–66% of refluxing units. DMSA scan abnormalities were present in 68% of units with reflux at rest, 61% of units with reflux on micturition and 86% of units with reflux on both resting and micturition phases. In comparison with contralateral units that did not reflux, the presence of reflux had a significant association with openness of the ureteric orifice (p<0.00001) and DMSA abnormality (p<0.005).
Conclusions
Reflux of any type is strongly associated with an open ureteric orifice. Units that reflux during both resting and micturition phases had a higher incidence of DMSA abnormality than those refluxing during one phase only, but this was not statistically significant.
Similar content being viewed by others
References
Wilkinson AG (2002) Percutaneous direct radionuclide cystography in children: description of technique and early experience. Pediatr Radiol 32:511–517
Nissenkorn I, Gil I, Servadio C, et al (1981) Radionuclide cystography: the significance of retention time of the refluxed isotope. J Urol 126:448–451
Smellie J, Edwards D, Hunter N, et al (1975) Vesico-ureteric reflux and renal scarring. Kidney Int 8:S65–S72
Verber IG, Strudley MR, Meller ST (1988) 99mTc dimercaptosuccinic acid (DMSA) scan as first investigation of urinary tract infection. Arch Dis Child 63:1320–1325
Weiss R, Tamminen-Mobius T, Koskimies O, et al (1992) Characteristics of children with severe primary vesicoureteral reflux. J Urol 148:1644–1649
Smellie J (1992) Management of children with severe vesicoureteral reflux. J Urol 148:1676–1678
Lebowitz RL, Olbing H, Parkkulainen KV, et al (1985) International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 15:105–109
Lebowitz RL (1992) The detection and characterisation of vesicoureteral reflux in the child. J Urol 148:1640–1642
Hellstrom M, Jacobsson B (1999) Diagnosis of vesico-ureteric reflux. Acta Paediatr Suppl 431:3–12
Chapman SJ, Chantler C, Haycock GB, et al (1988) Radionuclide cystography in vesicoureteric reflux. Arch Dis Child 63:650–671
Bower G, Lovegrove FT, Geijsel H, et al (1985) Comparison of ‘direct’ and ‘indirect’ radionuclide cystography. J Nucl Med 26:465–468
Poli-Merol ML, Francois S, Pfliger F, et al (1998) Interest of direct radionuclide cystography in repeated urinary tract infection exploration in childhood. Eur J Pediatr Surg 8:339–342
McLaren CJ, Simpson ET (2001) Direct comparison of radiology and nuclear medicine cystograms in young infants with vesico-ureteric reflux. BJU Int 87:93–97
Conway J (1984) Nuclide cystography and VUR. Contemp Nephrol 39:1–19
Conway JJ, Kruglik GD (1976) Effectiveness of direct and indirect radionuclide cystography in detecting vesicoureteral reflux. J Nucl Med 17:81–83
Mattar SG, Orr, JD, MacKinlay GA (1994) Endoscopic treatment of vesico-ureteric reflux in children by subureteric Teflon injection: the Edinburgh experience. J R Coll Surg Edinb 39:17–19
Merckx L, De Boe V, Braeckman J, et al (1995) Endoscopic submucosal Teflon injection (STING): An alternative treatment of vesicoureteric reflux in children. Eur J Pediatr Surg 5:34–36
Pollet JE, Sharp PF, Smith FW (1980) “Stasis”—a test for vesicoureteric orifice competence in children with reflux. Pediatr Radiol 9:213–215
Bailey RR (1992) Commentary: the management of grades 1 and 2 (nondilating) vesicoureteral reflux. J Urol 148:1693–1695
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Roger, M., Wilkinson, A.G. Cystoscopic and DMSA findings in relation to types of reflux demonstrated on percutaneous direct radionuclide cystography in children. Pediatr Radiol 34, 222–226 (2004). https://doi.org/10.1007/s00247-003-1070-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-003-1070-y