Direct Radionuclide Cystography Research Articles

Sources of error in direct radionuclide cystography in children and the need for a standardized, manometric apparatus.

Direct radionuclide cystography (DRC) is a safe and reliable method for the detection and follow-up of vesico-ureteral reflux (VUR). Since the first DRC was performed, during the early 60s, the method has undergone many refinements. Themanometric approach, which was first introduced in 1984, provides a correlation between the bladder pressure and VUR visualization. In this study the sources of error that may alter the results of DRC are discussed and a novel, standardized low costmanometric apparatus is suggested.

STUDI LITERATUR TEKNIK PEMERIKSAAN RADIOLOGI VESIKA URINARIA PADA PASIEN ANAK DENGAN KLINIS VESICOURETERAL RELFLUX (VUR)

Background: VUR (Vesicoureteral Reflux) is a condition in which urine flows back from the bladder to one or both ureters or sometimes to the kidneys. Several types of modalities are used to support this clinical examination. The modalities that can be used to support this examination include: Voiding Cystourethrography, DRCG (Direct Radionuclide Cystourethrography), ceVUS (Contrast Enhancement Voiding Urosonography), and MRI (Magnetic Resonance Imaging)
 Methods: This research is a type of research that is library research, a method of collecting library data or research where the object of research is explored through a variety of library information (books, proceedings, articles and scientific journals).
 Results: Radiological examination of the clinical bladder with VUR can be performed with various radiological modalities including Voiding Cystourethrography, Direct Radionuclide Cystography (DRCG), Magnetic Resonance Imaging (MRI), and Contrast Enhancement Urosonography (ceVUS). Each examination uses a contrast material that is adjusted to the modality used.
 Conclusions: From the various modalities that can be used, it is assessed from the level of effectiveness and efficiency as well as the minimum radiation exposure dose. The ceVUS technique is the most appropriate technique to describe VUR because it does not use ionizing radiation but this technique will be difficult to perform in certain conditions such as the pathological condition of the patient.

Types of Parenchymal Changes Diagnosed on DMSA Scans of Kidneys Affected by Different Grades of Vesicoureteral Reflux.

BackgroundRenal parenchymal damage and scarring usually is associated with urinary tract infection (UTI), whereas the impact of vesicoureteral reflux (VUR) on the kidneys is unclear. We aimed to compare kidneys with all grades of VUR (grades Io-V) and those without VUR by using direct radionuclide cystography, voiding cystourethrography, and findings from 99mTc-DMSA scintigraphy (DMSA scan).Material/MethodsThe present analysis included 253 renal ureteral units (RUU) from 129 children with VUR and recurrent UTI and children with a single febrile UTI associated with abnormal ultrasonographic findings. The 6 grades of VUR (Io, I, II, III, IV, and V) and 35 RUUs without VUR were divided into 4 groups: 1. Non-dilated VUR (grades Io-II); 2. Mildly dilated VUR (grade III); 3. Dilated VUR (grades IV–V); and 4. The control group.ResultsDMSA scanning showed significant differences between the groups with non-dilated VUR, grade III VUR, grades IV–V VUR, and the control group in kidney width (χ2=30.5; P<0.001); position and shape (χ2=30.6; P<0.001); intensity of activity (χ2=38.1; P<0.001); distribution of activity (χ2=34.5; P<0.001); and existence of scars (χ2=16; P<0.001). The probability of abnormalities on DMSA scans increased with the VUR grade. However, inside the groups of dilated and non-dilated VUR we found no significant statistical differences between those characteristics.ConclusionsOur results indicate that kidneys without VUR or with non-dilated lateral VUR and dilated VUR on the contralateral side represent 2 different categories of parenchymal changes.

Radionuclide techniques for the detection of vesicoureteral reflux and their clinical significance.

We discuss and try to evaluate the detection of vesicoureteral reflux (VUR) by radionuclide techniques and especially direct radionuclide cystography (DRC). Direct radionuclide cystography is applied for more than half a century mainly in children. Vesicoureteral reflux has a complex pathology not yet completely understood and is often related to urinary tract infection (UTI) and renal parenchyma scarring that can lead to long-term renal function impairment. Since there is no consensus on the optimal imaging algorithm after the first febrile urinary tract infection, many imaging strategies have been proposed for VUR detection in the last decade, including or not DRC. Views opposing or accepting its use are also presented.

Evaluation of cyclic direct radionuclide cystography findings with DMSA scintigraphy results in children with a prior diagnosis of vesicoureteral reflux.

Direct radionuclide cystography (DRC) with cyclic imaging is a sensitive method used for the detection of vesicoureteral reflux (VUR). Radionuclide cystography is generally recommended for follow-up evaluation of VUR. The aim of this study was to evaluate cyclic DRC with DMSA scan results during the follow-up period in children with a prior diagnosis of VUR. DRC findings of 85 children with VUR were evaluated together with DMSA findings during follow-up. VUR grade was classified anatomically as grades I, II, and III reflux. Reflux grades of II and III were regarded as high-grade reflux. Reflux was also graded functionally as transient and continuous on the basis of the presence of reflux on either filling or voiding phases (transient) or both phases (continuous) of at least one cycle. Among 85 children, 32 (38%) exhibited reflux. In five patients, reflux was observed on both sides, and a total of 37 refluxing units (RUs) were evaluated. According to the highest grade attained in either cycle, 31 (84%) units had grade II, five had grade I and one had grade III reflux. Reflux was continuous in 23 (62%) and transient in 14 (38%) RUs. The incidence of an abnormal scan result was higher in continuous reflux group (78%) than in high-grade anatomic reflux group (59%). The addition of a second cycle resulted in the diagnosis of continuous reflux in six (26%) more RUs. DMSA scan findings correlated significantly with functional reflux classification (P<0.05), but not with anatomic reflux classification (P>0.05). Functional classification of VUR into continuous and transient reflux resulted in higher correlation with DMSA scan findings compared with anatomic reflux grading in follow-up patients with VUR. Cyclic imaging contributed to continuous reflux diagnosis. The significance of functional information obtained from cyclic DRC in initial diagnostic workup, management, and follow-up of children with urinary tract infection needs to be determined with further studies.

Diagnostic Value of Technetium-99m-Dimercaptosuccinic Acid Scintigraphy in Prediction of Vesicoureteral Reflux in Children with First-time Febrile Urinary Tract Infection

Background: Imaging modalities such as voiding cystourethrography (VCUG), direct radionuclide cystography (DRNC), and renal cortical scintigraphy (RCS) with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA), are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR). However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC. Materials and Methods: Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI) who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed. Results: Analyses showed a sensitivity and specificity of 95.65% and 14.72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3.5-fold greater risk of having VUR than those with a normal scans (odds ratio=3.5; 95% confidence interval [CI]: 1.4-8.58; p=0.007). In addition, the risk of VUR is up to 7.0-fold greater in children with moderate renal involvement (odds ratio=7.0; 95% CI: 2.6-13.2; p<0.0001) and up to 9.2-fold greater in children with severe renal involvement (odds ratio=9.2; 95% CI: 3.2-17.3; p=0.007) in the Tc-99mDMSA scans compared to those with a normal scans. Conclusion: According to the results, Tc-99mDMSA scan can be used as a screening test in prediction of VUR in infants and children with first- time febrile UTI.

Value of direct radionuclide cystography in diagnosing vesico-peritoneal fistulae.

A 36-year-old female patient underwent a laparoscopic surgery to remove a uterine fibroid. The procedure failed to relieve the pelvic pain, although its nature changed. After a period of observation, the patient was re-admitted to hospital on suspicion of a vesico-uterine fistula to be differentiated with endometriosis. Diagnostic investigations - cystography, cystoscopy, computed tomography and magnetic resonance - did not reveal a fistula. Laparoscopy was performed, with a possible biopsy in order to eliminate endometriosis. The result was negative, but chronic progressive reactive/inflammatory lesions were noticed, possibly indicating the presence of a vesico-peritoneal fistula. Therefore, a direct radionuclide cystography was performed. The scintigraphic images single-photon emission computed tomography (SPECT/CT) showed a radioactive spot, indicative of a vesico-peritoneal fistula. The fistula was treated for three months by catheterisation of the urinary bladder. The follow-up SPECT-CT did not reveal any urine leakage from the bladder. The clinical symptoms disappeared as well.

Long-term follow-up of trigonoplasty antireflux operation.

Open trigonoplasty antireflux operation has been associated with promising results. However, its success in controlling reflux has not been evaluated in the long term. All patients who underwent trigonoplasty for vesicoureteral reflux by one surgeon from 2004 to 2014 were included. Preoperative evaluations included direct radionuclide cystography (DRNC) or voiding cystourethrography, urine analysis and culture and abdominal sonography. Urodynamic study and cystoscopy was performed in selected patients. Trigonoplasty was done by a modified Gil-Verent method. The latest available patients' DRNCs were used to judge for reflux relapse. Ninety-one patients, 142 refluxing units; median (range) age, 10.5 (1-45) years; M/F, (11/80) were followed for 18 to 135 months. Reflux resolution rate was 73.6% for patients and 75.4% for refluxing units. Relapse was associated with reflux grade (67% in grade V), ureteral orifice appearance (40% in golf hole/stadium), and patients with a history of pyelonephritis. Multivariable model based on the above variables had less than 10% sensitivity in predicting relapse. Trigonoplasty success rate can decrease with long-term follow-up.

Cyclic Direct Radionuclide Cystography in the Diagnosis and Characterization of Vesicoureteral Reflux in Children and Adults.

To investigate the influence of cyclic direct radionuclide cystography (RNC) on the diagnosis of vesicoureteral reflux (VUR) in children and adults. A total of 362 examinations were performed in patients with a mean age of 15.8 ± 17.2 years (2 months to 76.4 years, 89.5% female). The examinations were divided into 3 groups of age: A, younger than 5 years; B, 5 years and younger than 14 years; and C, older than 14 years. Repeated cycles of bladder filling without removal of the catheter were performed. VUR was diagnosed in 21% of patients based on the first cycle, 5.5% in the second cycle, and 2.5% only in the third cycle. Most examinations showing VUR corresponded to grade II. Reflux occurred in only the filling phase in 10%, only the voiding phase in 27%, and both phases in 63% of patients. There was a higher incidence of reflux in groups A and B than group C after the first cycle. The second cycle was equally effective in diagnosing VUR in all 3 groups. In group A, the third cycle was more effective compared to the other groups. Performing a second and a third cycle in RNC yielded an additional VUR diagnosis of 35.7%, as compared to performing only 1 cycle. The second cycle showed efficacy in all the groups, whereas the third cycle diagnosed more VUR only in group A. These results confirmed the importance of performing additional cycles in RNC for VUR diagnosis, both in children and adults.

MP17-19 QUANTITY ASSESSMENT OF VESICOURETERAL REFLUX BY DIRECT RADIONUCLIDE CYSTOGRAPHY

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2015MP17-19 QUANTITY ASSESSMENT OF VESICOURETERAL REFLUX BY DIRECT RADIONUCLIDE CYSTOGRAPHY Zukhra Sabirzyanova, Andrey Pavlov, Dmitry Fomin, and Gevorg Simonyan Zukhra SabirzyanovaZukhra Sabirzyanova More articles by this author , Andrey PavlovAndrey Pavlov More articles by this author , Dmitry FominDmitry Fomin More articles by this author , and Gevorg SimonyanGevorg Simonyan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Usually a grade of vesicoureteral reflux can be define by roentgen micturition cistography, at the same time the radionuclide methods may help only in its quality diagnostic, answering the question about its presenting, but not about it's grade. The advantages of radionuclide method are minimal radiation dose and possibility attentively track whole process of filling and empting a bladder. We evaluate the diagnostic value of direct radionuclide cystography in comparing with “gold standard” - micturition cystourethrography (MCUG) in the detecting of the grade of vesicoureteral reflux (VUR) METHODS 150 children in the age of from 3 month to 14 years with VUR were detected by both methods - direct radionuclide cystography and MCUG. Imaging parameters, which were described by direct radionuclide cystography, includes volume of bladder when VUR occurs, duration of VUR and its activity. Activity of VUR was measured as a relevance quantity of nuclear tracer in ureter comparing to its activity in bladder RESULTS VUR grade 4 was found in 22 children. On direct radionuclide cystography, it was characterized by active VUR, when the activity in ureter was more than 15% comparing the activity in bladder. In 10 cases, it occurs on the small bladder volume less than 50% of effective volume, in others the bladder volume was 50–70%. There were prolonged VUR more than 120sec.in all cases. VUR grade 3 was detected in 40 children by MCUG. On radionuclide method, it was completely confirm in all patients. Its activity in 15 of them was 2,5%-5% with bladder volume less 50% from effective, in 10 5–7,5% on bladder volume above 50% from effective volume, in 15 there was 8–10% activity on bladder volume 60–80% from effective one. Duration of VUR was very different, from 10sec. until 110sec. Among 98 children where the radionuclide cystography found VUR activity less than 3,5% on the bladder volume near effective (80–100%) with it different duration MUCG confirm VUR grade 2 in 40 and VUR grade 1 in 45, in others 13 cases VUR was not confirm by roentgen cystography CONCLUSIONS direct radionuclide cystography is effective method not only for detecting VUR, as well to describe its grade. Activity of nuclear tracer in ureter comparing its activity in bladder significant describe the grade. Bladder volume when the VUR occurs is the indirect indication. Moreover, the duration of VUR does not describe its grade. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e183-e184 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zukhra Sabirzyanova More articles by this author Andrey Pavlov More articles by this author Dmitry Fomin More articles by this author Gevorg Simonyan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The value of direct radionuclide cystography in the detection of vesicoureteral reflux in children with normal voiding cystourethrography.

Vesicoureteral reflux (VUR) is one of the most important risk factors for urinary tract infection (UTI). Diagnosis and treatment of VUR is important to prevent irreversible complications, such as renal scarring and chronic renal failure. This study was conducted to assess the value of direct radionuclide cystography (DRNC) in the detection of VUR in children with UTI and a normal voiding cystourethrography (VCUG). DRNC was performed in 35 children with a normal VCUG after an episode of febrile UTI who had hydronephrosis or hydroureter, abnormal acute dimercaptosuccinic acid (DMSA) scan results and/or febrile UTI recurrence. This study was conducted in the nephrology department of Mofid Children's Hospital, Tehran (Iran). The results were statistically analyzed. Among the 70 ureters studied, 33 (49.1 %) were observed to have VUR. Of these, 17 (51.5 %) had mild, 14 (42.4 %) moderate, and 2 (6.1 %) severe reflux. A significant relationship was observed between DRNC results and DMSA renal scan findings (P < 0.05). Based on our results, we suggest that DRNC may reveal VUR despite a normal VCUG in children with hydronephrosis, abnormal acute DMSA, and/or recurrent febrile UTI.

Endoscopic correction of primary VUR by using polyacrylate polyalcohol copolymer (Vantris) in young girls: 2-Year follow-up

ObjectiveOur aim was to evaluate the efficacy and safety of single endoscopic injection of Vantris in young girls affected by primary vesicoureteral reflux (VUR) at more than 2 years of prospective follow-up. Material and methodsOver the last 4 years, 73 girls with primary VUR of grades (G) I–IV underwent a single endoscopic injection of Vantris. The mean age was 8.48 (SD = 4.8) years. VUR was unilateral in 73 and bilateral in 13 patients, comprising 86 renal refluxing units (RRUs). Pre-operative evaluation consisted of: blood biochemistry, urine analysis and culture, ultrasound scan, voiding cystourethrogram (VCUG), and dimercaptosuccinic acid (DMSA) renal isotope scan. Patients were followed using ultrasound scans at 1 month and every 3 months for the first year and then 2 years after injection. Direct radionuclide cystography with technetium pertechnetate was performed at 3 and 12 months after injection. VCUG was performed only in confirmed cases of failure and downgraded VUR at 3, 12, and 24 months after endoscopic correction. ResultsSixty-nine (95%), 61 (83.4%), and 52 (71%) patients completed 3, 12, and 24 months' follow-up respectively. VUR was corrected and downgraded to G I in 81% and 3.3% of RRUs at 3 months' follow-up. The corrected and downgraded RRUs at 12 and 24 months' follow-up were 77%, 10%, and 77%, 11% respectively. De novo contralateral G I VUR was demonstrated in 8.6% of normal ureters. Contralateral GI VUR with normal DMSA isotope renal scans was resolved in 71% of RRUs. Febrile urinary tract infection decreased to 4.1% in the patients. ConclusionAccording to our study, a single Vantris injection provides a high level of efficacy and safety in the treatment of primary G I–IV VUR in young girls, at 2 years' prospective follow-up.

Vesicorectal fistula detected on direct radionuclide cystography — importance of fecal matter imaging

We report an 11 year old male patient with the history of imperforate anus, which was repaired surgically 4 years ago. He has been complaining of intermittent passing of urine into the rectum recently. The vesicorectal fistula in this patient was proven by imaging of the fecal matter post direct radionuclide cystography study. Our case showed that nuclear medicine imaging can be extended to unanimated objects such as patients' excrements or fluids with important diagnostic yields.

2023 THE EFFECTIVENESS OF DIFFERENT DIAGNOSTIC METHODS IN DETECTION OF VESICOURETERAL REFLUX IN CHILDREN

INTRODUCTION AND OBJECTIVES: Evaluate the diagnostic value of direct radionuclide cystography, indirect radionuclide cystography dynamic nephroscintigraphy with voiding sample in comparing with “gold standard” micturation cystourethrography (MCUG) in the detecting of the vesicoureteral reflux (VUR). We assess three methods and made the indications for each of them. METHODS: Two groups of patients with VUR grade 2-4 were conducted. The first group included 72 patients (42 boys, 30 girls) in the age from 4 months to 18 years who were evaluated comparatively according to the results of indirect radionuclide cystography and MCUG; the second 20 patients in the age from 5 months to 8 years (5 girls, 15 boys) were evaluated with direct radionuclide cystography in comparing of MCUG. RESULTS: In the first group VUR was detected in 23 cases according to MCUG, in 33 according to indirect radionuclide cystography, in 16 by both methods. It should be noted that the discrepancy between the results was found in 59.7% of children aged from 6 months to 3 years with the VUR grade 2-3. In the second group 16 patients demonstrated matching results for both methods; 4 patients showed a discrepancy between the results: in 3 patients two-sided VUR was detected by direct radionuclide cystography but only one-side VUR by MCUG. CONCLUSIONS: Indirect radionuclide cystography is the method of choice in children elder than 3 years old. Direct radionuclide cystography in contrast to an indirect one provides a reliable and objective assessment of the presence of VUR in both filling and emptying phases of the bladder, as well as allowing to determine the functional capacity which causes VUR, its intensity and duration.

Predict the spontaneous resolution of vesicoureteral reflux by direct radionuclide cystography

To evaluate the prognostic value of initial direct radionuclide cystography (DRC) for spontaneous resolution of vesicoureteral reflux (VUR). Fifty-one children with initial diagnosis and 1-6 years' follow-up of VUR by DRC were enrolled in this study. VUR was graded according to the anatomic grading as (1) mild reflux corresponding to tracer just in ureter, (2) moderate reflux with accumulation of activity in a non-dilated collecting system and ureter, and (3) severe reflux equated with a dilated ureter and collecting system. The severity of VUR was also expressed according to the functional classification as (1) transient reflux, which occurred at filling or voiding phase only and (2) persistent reflux, present in both filling and voiding phases. Twenty-nine of the 51 children had unilateral VUR, and the other 22 had bilateral VUR. In the total of 73 refluxing ureters, there were 12 mild, 49 moderate and 12 severe VUR according to anatomic grading, and 30 transient and 43 persistent VUR according to the functional grading. After follow-up, resolution of VUR was found in 92% (11/12) of mild, 59% (29/49) of moderate and 25% (3/12) of severe VUR (P=.04, mild vs. moderate; P=.003, mild vs. severe). Eighty percent (24/30) of transient and 44% (19/43) of persistent reflux showed spontaneous resolution (P=.003). DRC allows anatomic and functional classification of VUR. It is an ideal method for the diagnosis, staging and follow-up of VUR, and provides valuable information to predict the patient's outcome.

Predict the spontaneous resolution of vesicoureteral reflux by direct radionuclide cystography

ObjectivesTo evaluate the prognostic value of initial direct radionuclide cystography (DRC) for spontaneous resolution of vesicoureteral reflux (VUR). MethodsFifty-one children with initial diagnosis and 1–6 years’ follow-up of VUR by DRC were enrolled in this study. VUR was graded according to the anatomic grading as (1) mild reflux corresponding to tracer just in ureter, (2) moderate reflux with accumulation of activity in a non-dilated collecting system and ureter, and (3) severe reflux equated with a dilated ureter and collecting system. The severity of VUR was also expressed according to the functional classification as (1) transient reflux, which occurred at filling or voiding phase only and (2) persistent reflux, present in both filling and voiding phases. ResultsTwenty-nine of the 51 children had unilateral VUR, and the other 22 had bilateral VUR. In the total of 73 refluxing ureters, there were 12 mild, 49 moderate and 12 severe VUR according to anatomic grading, and 30 transient and 43 persistent VUR according to the functional grading. After follow-up, resolution of VUR was found in 92% (11/12) of mild, 59% (29/49) of moderate and 25% (3/12) of severe VUR (P=.04, mild vs. moderate; P=.003, mild vs. severe). Eighty percent (24/30) of transient and 44% (19/43) of persistent reflux showed spontaneous resolution (P=.003). ConclusionsDRC allows anatomic and functional classification of VUR. It is an ideal method for the diagnosis, staging and follow-up of VUR, and provides valuable information to predict the patient's outcome.

Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update

Voiding urosonography (VUS) entails the intravesical administration of US contrast agent (USCA) for the diagnosis of vesicoureteric reflux (VUR). VUS is now recognized as a practical, safe, radiation-free modality with comparable or higher sensitivity than direct radionuclide cystography (DRNC) and voiding cystourethrography (VCUG), respectively. An extensive review of the literature regarding both the procedural aspects and comparative diagnostic values of VUS has been published (Darge Pediatr Radiol 38:40-63, 2008a, b). The aim of this review is to provide an update on various facets of VUS that have taken place since the publication of the above-mentioned two reviews.

Success of Trigonoplasty Anti-Reflux Surgery and Its Predictive Factors

Introduction: This study was designed to evaluate factors contributing to failure in Gil-Vernet antireflux operation. Materials and Methods: 96 patients (150 refluxing units; median (range) age, 60 (12–180) months; M/F, 11/85) with primary vesico-ureteral reflux were included. Trigonoplasty was done according to a modified Gil-Verent procedure. Relapse was diagnosed on the postoperative direct radionuclide cystography (DRNC) 3 or 6 months after operation. Demographic and intraoperative data were used to assess factors contributing to failure. Results: Resolution of reflux in postoperative DRNC was observed in 87 patients (90.6%) and in 138 refluxing units (92.0%). In patients who were followed 3–6 months, one relapse occurred (3%) versus 8 relapses in those who were followed 24–39 months (12%). Relapse in refluxing units was related to the history of voiding symptoms (30 vs. 3%, p < 0.001), history of breakthrough infections (20 vs. 3%, p = 0.001), golf or stadium like ureteral orifice appearance (15 vs. 4%, p = 0.02), and less distance of ureteral orifices from each other (p < 0.001). Conclusions: Trigonoplasty success rate may decrease with long-term follow-up. In multivariable analysis, patients with history of voiding dysfunction, breakthrough infection, golf/stadium like ureteral orifices, and less distant ureteral orifices are at a higher risk of relapse.

Direct radionuclide cystography imaging in colovesical fistula due to inguinal hernia operation complication

Colovesical fistula is an abnormal connection between the enteric and urinary systems, usually sigmoid colon, caused by various conditions. One cause of colovesical fistula is iatrogenic injury, such as induced by inguinal hernia surgery. We present a case of colovesical fistula. A 57-year-old male was admitted to a local hospital with complaints of dysuria and pneumaturia. He had a past history of total extraperitoneal laparoscopic inguinal hernia repair operation 7 years previously for bilateral inguinal hernia. The case was assessed with radiologic and scintigraphic techniques. Radiologic techniques (plain abdominal radiography, intravenous pyelogram, ultrasound examination, double-contrast barium enema, CT, MRI) were inadequate to determine the colovesical fistula. The colovesical fistula was visualized with direct radionuclide voiding cystography as an alternative scintigraphic method.

Which cystography in the diagnosis and grading of vesicoureteral reflux?

The gold standard procedure for the evaluation of vesicoureteral reflux (VUR) is the radiographic voiding cystourethrography (VCUG); direct radionuclide voiding cystography (DRVC) is an alternative method for detecting VUR. A new imaging procedure, voiding urosonography (VUS) with contrast medium, has recently been introduced. We have carried out a comparative study of these three techniques in 157 patients (aged 6 weeks-4.7 years). VUS showed the presence of VUR in 91 of 311 renal units; VCUG detected reflux in 64 of 233 renal units, and the DRVC in 23 of 78 renal units. VCUG and VUS were compared in 118 patients, and both procedures showed the same grade of reflux in 56 refluxing units (kappa value 0.92); in six cases the reflux grade was greater at VUS than at VCUG. Seven cases of reflux detected by VUS were not identified on VCUG. VCUG did not show a grade of VUR that was higher than in VUS in any patient. In the identification of 4 degrees-5 degrees grade reflux, the sensitivity of VUS reached 100%. VUS and DRVC were found to be equally effective in the detection of VUR (kappa value 0.85). In conclusion, we found that VUS is a useful method for the diagnosis and grading of patients with VUR.