Radionuclide cystography in the management of vesico-ureteric reflux

The diagnosis of vesico-ureteral reflux. Radiologic and nuclear medicine methods

Video voiding cystourethrography in 47 patients was compared to 99mTc cystography performed suprapubically in 20 patients and 123I Hippuran renocystography performed in 43 patients. The degrees of reflux were equally distributed through the grades. 99mTc cystography was negative in 4 of 5 grade 2 refluxes and positive in 4 out of 5 grade 3-4 refluxes. Computerized dynamic tracings of the 123I renocystography showed an activity level increase over the kidneys of more than 1% of the bladder activity level in 47 units, 18 were equivocal and 21 negative. Grade 2 and 3 reflux found on the video VCU was refound on the renocystography. 24 false positives were found. It is concluded that 99mTc cystography performed as in our unit adds no further information to the diagnosis of reflux and that 123I renocystography diagnosing the more severe degrees of reflux may be a future method of non-invasive reflux control.

Intravenous radionuclide cystography for the detection of vesicorenal reflux

Intravenous radionuclide cystography using a single intravenous injection of 99mtechnetium diethylenetriaminepentaacetic acid, provides information on individual kidney function, coarse anatomy and vesicorenal reflux. This study investigates the effectiveness of intravenous radionuclide cystography in detecting reflux. In 58 children intravenous radionuclide cystography detected 53 ureters with reflux compared to 32 detected by voiding cystography. This difference was investigated further with patients in whom other test suggested reflux. While there was no statistically significant difference for patients having pyelonephritis or hydronephrosis, intravenous radionuclide cystography detected significantly more ureters with reflux in patients with abnormal ureteral orifices or infected urine and, therefore, predisposed to reflux. Intravenous radionuclide cystography is a more comprehensive and sensitive test for vesicorenal reflux than voiding cystography.