Radionuclide Voiding Cystography In Intrarenal Reflux Detection

In order to evaluate the possibility of detecting intra-renal reflux (IRR) with a more sensitive procedure, 48 children with recurrent urinary tract infections underwent intravenous urography (IVU) and voiding cystourethrogram (VCU) using a solution containing contrast medium and 99mTc-sulfur colloid particles which are known to persist in the renal parenchyma for a long time. Scintigraphic images were taken at 5 and 20 hours after VCU. 18 children had no vesico-ureteral reflux, 11 showed unilateral and 19 bilateral VUR, which was therefore present in 49 renal units. Among the 49 renal refluxing units (RRUs) IRR was detected radiologically in 8; of these isotopic activity in the renal area was present in all 6 RRUs who were examined at 20 hours. Of the remaining 41 RRUs with no radiologically detectable IRR 24 were evaluated at 20 hours and 5 (21%) showed renal radioactivity. Renal scars were significantly more frequent in kidneys with radioisotopic activity at 20 hours. The results of this study indicate that radionuclide cystography using 99mTc-sulfur colloid is a reliable procedure for demonstrating IRR, and to this end is more sensitive than X-ray VCU. Radionuclide cystography with sulfur colloid particles should therefore be considered a simple and useful complementary procedure, which is more sensitive than X-ray VCU in the diagnosis and follow-up of IRR.