Direct Radionuclide Voiding Cystography Research Articles

Urinary Tract Infection in Infants: A Single-Center Clinical Analysis in Southern Taiwan

This study summarized the epidemiology, etiology, and susceptibility of pathogens to antibiotics, and specific characteristics in infants aged less than 4 months diagnosed with urinary tract infection in the past decade in Taiwan. The medical charts of patients aged less than 4 months admitted for urinary tract infection to Kaohsiung Veterans General Hospital between January 2001 and December 2009 were retrospectively reviewed. A total of 132 patients, with male predominance (68.9%), were enrolled. The top three pathogens were similar to those identified in previous studies in Taiwan. The most common pathogen, Escherichia coli (85.3%), was resistant to ampicillin (75.9%), followed by sulfamethoxazole/trimethoprim (31.7%), and cefazolin (28.5%). Dimercaptosuccinic acid (DMSA) renal scan revealed 34.5% positive findings, while the vesicoureteral reflux (VUR) rate was 37.8% by direct radionuclide voiding cystography and/or voiding cysto-urethrography. Positive DMSA findings significantly correlated with VUR (p<0.001) and higher C-reactive protein level (p<0.05). E coli was the most common pathogen in the present cohort, and the top three pathogens were similar to those found in general pediatric population in Taiwan. VUR was the most common genitourinary tract anomaly in this age group. Positive DMSA was well correlated with VUR and higher C-reactive protein level.

Comparative Study of Color Doppler Voiding Urosonography Without Contrast Enhancement and Direct Radionuclide Voiding Cystography for Diagnosis of Vesicoureteric Reflux in Children

Most available studies investigating the diagnostic accuracy of color Doppler voiding urosonography in the detection of vesicoureteric reflux used an echo contrast agent. It is unknown whether echo contrast agents are necessary for diagnosis or follow-up of vesicoureteric reflux. We compared color Doppler voiding urosonography without contrast enhancement and direct radionuclide voiding cystography in the detection and grading of vesicoureteric reflux with respect to the sex and age of patients as well as the severity of reflux. In the 66 patients enrolled (56 girls and 10 boys), 132 renoureteral units were investigated. All patients under went Doppler voiding urosonography and direct radionuclide voiding cystography within 3 hours. Direct radionuclide voiding cystography was used as the reference standard. Our results indicate good overall sensitivity (83%) and specificity (77%) for color Doppler voiding urosonography without contrast enhancement in comparison with direct radionuclide voiding cystography. As the age of the patients decreased, the sensitivity of urosonography increased, reaching 100% among patients younger than 1 year. In the comparison of different grades of reflux severity, we found that the sensitivity and specificity were elevated as the grade increased (both parameters reaching 100% in the most severe cases). Severity grading was equal between the two methods. We have shown that Doppler voiding urosonography without contrast enhancement is a comparably reliable method versus direct radionuclide voiding cystography in the detection and grading of vesicoureteric reflux, especially at higher grades of reflux and in children younger than 1 year.

Comparative Study of Color Doppler Voiding Urosonography Without Contrast Enhancement and Direct Radionuclide Voiding Cystography for the Diagnosis of Vesicoureteric Reflux in Children

Objectives: We aimed to compare color DUS without the application of contrast enhancement and direct radionuclide voiding cystography (DRC) to assess the capability of color DUS without contrast in the detection and grading of VUR with respect to the sex and age of patients, as well as the severity of VUR. Material and Methods: In the 66 patients enrolled (56 girls, 10 boys), 132 reno-ureteral units were investigated. All patients underwent DUS and DRC within 3 hours. DRC was used as the reference standard. Results: Our results indicate a good overall sensitivity (83%) and specificity (77%) of color DUS without contrast enhancement in comparison with DRC. As the age of the patients decreased, the sensitivity of DUS increased, reaching 100% among patients below one year of age. Upon the comparison of different grades of VUR severity, we found that sensitivity and specificity elevated as the grade increased (both parameters reaching 100% in the most severe cases). Conclusion: We have demonstrated that DUS is a comparably reliable method to DRVC in the detection and grading of VUR especially at higher grades of VUR, even without the application of echo contrast agents. In high grades of VUR, the diagnosis and follow-up can be safely and reliably performed without the application of an US contrast medium. However, for an accurate diagnosis and grading, especially at lower grades, the application of a contrast medium can be recommended when US is performed.

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.

Cyclic direct radionuclide voiding cystography: Increasing reliability in detecting vesicoureteral reflux in children : J.J. Fettich and R.B. Kenda. Pediatr Radiol 22:337–338, (September), 1992

Cyclic direct radionuclide voiding cystography: Increasing reliability in detecting vesicoureteral reflux in children : J.J. Fettich and R.B. Kenda. Pediatr Radiol 22:337–338, (September), 1992

Cyclic direct radionuclide voiding cystography: increasing reliability in detecting vesicoureteral reflux in children.

The purpose of this study was to establish the sensitivity of cyclic direct radionuclide cystography (RVC) in detecting vesicoureteral reflux (VUR) in infants and small children, and to compare it to the conventional (one cycle only) RVC. 428 patients (856 renal units) were admitted to the study from January 1991 through March 1992 and all had a cyclic RVC. The age of the patients ranged from 4 months to 7 years. The overall agreement of both cycles in detecting VUR in this study was 45%, the lowest being in detecting VUR I (36%), and the highest in detecting VUR III (86%). If we had used a conventional RVC (the first cycle only), 17 (29%) VUR I, 50 (36%) VUR II and 3 (9%) VUR III, which were detected in the second cycle only, would have been missed. We conclude that cyclic RVC detected 43% more VURs than the conventional (first cycle only) RVC, and would therefore recommend its use as a standard procedure instead of the conventional RVC.

Detecting vesico-ureteral reflux in asymptomatic siblings of children with reflux by direct radionuclide cystography

The incidence of vesicoureteral reflux (VUR) among asymptomatic siblings of children with VUR is much higher than the estimated incidence in the general population. It might be expected that identifying them and keeping them under close observation and/or either surgical or conservative treatment, might reduce the risk of renal scarring. Fifty-three asymptomatic children, all under 6 years of age and all siblings of children with proven VUR, were studied and direct radionuclide voiding cystography (DRVC). There were 31 (58%) boys, and 22 (42%) girls. Nine children (17%) were younger than 1 year, 13 (25%) were between 1 and 2 years of age, while 31 (58%) were older than 2 years. VUR was detected in 22 (42%) of the 53 siblings. The incidence of VUR varied considerably according to the age, and sex of the child, the highest being in boys younger than 1 year. Most of the severe reflux was seen in children under 2 years of age. Out of 11 patients with VUR, grade 2 and 3, there were 10 younger than 2 years, whereas, only 2 of the 11 siblings with VUR, grade 1 were younger than 2 years of age. The mean age of children with VUR grades 2 and 3 was 19 months, compared to the mean age of 50 months for those with VUR grade 1. DRVC, a highly sensitive method, exposes the patient to much less radiation than X-ray voiding cystography. We believe that the benefit of detecting VUR in asymptomatic siblings with DRVC outweights the invasiveness of the procedure. The predictive value of positive family history alone in identifying VUR in our study was 42%.(ABSTRACT TRUNCATED AT 250 WORDS)