Direct radionuclide cystography by supra-pubic puncture: comparison with conventional voiding cystourethrography.

Abstract

Vesicoureteric reflux (VUR) and its complications are common problems encountered in paediatric practice. Voiding cystourethrography (VCU) is the primary investigation of choice. Direct radionuclide cystography (DRC) is utilized in the follow-up evaluation of children diagnosed with VUR. However, VCU and DRC both require catheterization, which children do not tolerate well. In this prospective study we evaluated radionuclide cystography by direct supra-pubic puncture (SDRC) and instillation of the radiotracer into the bladder, avoiding catheterization. The results of this procedure were then compared with those of VCU. A total of 43 children (eight females and 35 males; mean age, 5.73+/-3.28 years; range, 1.5-12 years) were studied. Out of the total 86 renal units, SDRC showed VUR in 22, whereas VCU showed VUR in 29. The SDRC and VCU results were concordant in 77 (90%) out of 86 renal units in the detection of VUR. The sensitivity, specificity, positive predictive value, and negative predictive value of SDRC when compared to VCU were 75.86%, 100%, 100% and 89%, respectively. The overall accuracy of SDRC was 91.86%. The supra-pubic direct radionuclide cystography is a simple technique for detecting as well as grading VUR. The technique avoids catheterization, is well tolerated by children and is without significant side effects.