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Enhanced detection of vesicoureteric reflux with isotopic cystography
C Polito1, P F Rambaldi, A La Manna
1Department of Pediatrics, Second University of Naples, Italy. nobili@unina.it
Insights
Isotope cystography (IC) is more accurate than fluoroscopic cystourethrography (FC) for diagnosing vesicoureteric reflux (VUR) in children. IC is recommended as the primary diagnostic method for VUR.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Radiology
Background:
- Vesicoureteric reflux (VUR) is a common condition in children, potentially leading to kidney damage.
- Accurate diagnosis of VUR is crucial for timely intervention and management.
- Current diagnostic methods include isotope cystography (IC) and fluoroscopic cystourethrography (FC).
Purpose of the Study:
- To compare the diagnostic accuracy of IC and FC in detecting VUR in pediatric patients.
- To determine which imaging modality is superior for the initial diagnosis of VUR, including severe grades.
- To evaluate the concordance rates between IC and FC in identifying VUR.
Main Methods:
- A comparative study involving 124 children (56 boys, 68 girls) aged 1 month to 9.2 years with suspected VUR.
- Consecutive enrollment over a 10-month period.
- Both IC and FC were performed on all participants to assess for VUR.
Main Results:
- VUR was diagnosed in 41% of patients (51 out of 124).
- IC demonstrated significantly higher accuracy than FC in detecting VUR across all grades (P=0.00001) and severe VUR (P=0.004).
- FC missed VUR in 45% of diagnosed cases, including 12 instances of severe VUR detected by IC.
Conclusions:
- IC is significantly more accurate than FC for the initial diagnosis of VUR in children.
- IC is the preferred imaging modality for the first-time diagnosis of VUR, including severe cases.
- Boys diagnosed with VUR via IC require subsequent FC to screen for posterior urethral valves.
Abstract:
We compared the accuracy of isotope cystography (IC) and fluoroscopic cystourethrography (FC) in detecting vesicoureteric reflux (VUR) in children. FC and IC were performed in 124 children, 56 boys and 68 girls, aged 1 month to 9.2 years (mean 2.1 years), admitted consecutively for suspected VUR over a 10-month period. VUR was diagnosed by one or both studies in 51 of 124 (41%) patients. The two methods were concordant for the detection of VUR in 84% of kidney-ureter units and in 93% for the detection or exclusion of severe VUR. IC detected VUR more accurately than FC, both when all grades of VUR were considered together (P=0.00001) and when only severe reflux was considered (P=0.004). VUR was missed by FC in 23 of 51 (45%) subjects. Of those 23, 12 had severe VUR detected on one side at least by IC. VUR was missed by IC in 3 subjects. IC is significantly more accurate than FC in the initial diagnosis of VUR, even of severe grade. IC is the method of choice for the first diagnosis of VUR. Boys with VUR diagnosed by IC also need FC to investigate for posterior urethral valves.