DMSA Scan Research Articles

Assessment of the Effects of Access Count in Percutaneous Nephrolithotomy on Renal Functions by Technetium-99m-Dimercaptosuccinic Acid Scintigraphy

Objective. To determine the effects of percutaneous nephrolithotomy on renal functions by using DMSA scintigraphy while considering access counts. Material and Methods. A total of 37 patients who had undergone percutaneous nephrolithotomy were included. Preoperative DMSA scans were performed a day before the surgery, whereas postoperative scans were randomized by evaluating them before (n = 25) and after (n = 12) the 6th postoperative month. Twenty-six of 37 cases underwent percutaneous nephrolithotomy with a single access site and 11 with multiple access sites. Results. There were no significant changes of total renal functions in the whole study group (P = 0.054). In the single access group, total functions were significantly elevated (P = 0.03) In the multiple access group, while treated site functions were significantly decreased (P = 0.01), total functions did not change significantly (P = 0.42). There was an insignificant decrease in those evaluated before the 6th postoperative month (P = 0.27) and an insignificant increase in the others (P = 0.11). Conclusion. We could not find a superiority of single access over multiple accesses. There is a temporary functional loss in the treated site.

648 EVOLUTION OF DILATING VESICOURETERAL REFLUX DURING INFANCY USING A CONSERVATIVE MANAGEMENT PROTOCOL

You have accessJournal of UrologyPediatrics: Urinary Tract Infection/Vesicoureteral Reflux1 Apr 2013648 EVOLUTION OF DILATING VESICOURETERAL REFLUX DURING INFANCY USING A CONSERVATIVE MANAGEMENT PROTOCOL Aaron Martin, Muhammad Iqbal, Bruce Sprague, H. Gil Rushton, Craig Peters, and Hans Pohl Aaron MartinAaron Martin Washington, DC More articles by this author , Muhammad IqbalMuhammad Iqbal Washington, DC More articles by this author , Bruce SpragueBruce Sprague Washington, DC More articles by this author , H. Gil RushtonH. Gil Rushton Washington, DC More articles by this author , Craig PetersCraig Peters Washington, DC More articles by this author , and Hans PohlHans Pohl Washington, DC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Dilating vesicoureteral reflux (VUR) heightens concern by physicians and parents that an infant is at risk for recurrent urinary tract infection and renal injury. Consequently, corrective surgery is offered while children are quite young if VUR doesn't improve promptly. Current published resolution rates likely do not reflect the true natural history of VUR but rather a bias towards surgical intervention. We analyzed a cohort of infants with dilating VUR managed initially by a conservative non-operative protocol to determine factors related to improvement and resolution of VUR. METHODS The medical records of 90 infants (≤6 months) from 2004 to 2010 presenting for antenatal hydronephrosis or initial febrile urinary tract infection and found to have dilating VUR (grade≥3) were reviewed. All patients were placed on continuous antibiotic prophylaxis of the treating physician's choice and had an initial DMSA scan. Patients with VUR associated with secondary causes or those with non-dilating VUR (grades <3) were excluded. Variables of interest included initial presentation, initial DMSA results, gender/circumcision status, presence of breakthrough UTIs, initial grade of VUR, and presence of bilateral VUR. Regression analysis was performed to determine predictors of spontaneous resolution and/or improvement (grade<3) as well as predictors of surgical intervention. RESULTS A total of 80 infants (113 refluxing renal units) had complete follow-up studies and were included in the final analysis. A combined 50 patients (63%) had resolution (26/80) or improvement to grade <3 (24/80) with a mean follow-up of 29 months prior to resolution and/or discharge. Only 19 patients (24%) underwent surgery (mean age 29 months, range 1-76). Multivariate analysis revealed initial DMSA scan status, occurrence of breakthrough UTIs, circumcision status, and initial VUR grade to be predictors of VUR resolution/improvement (p<0.05). Initial presentation and presence of bilateral VUR were not predictive. DMSA scan abnormalities, clinical presentation, circumcision status, and breakthrough febrile UTIs were all significant predictors of surgery (p<0.05). CONCLUSIONS Dilating VUR in infancy has significant rates of spontaneous resolution/improvement. Therefore, surgery should be recommended based on objective predictors of non-resolution or renal injury after a reasonable period of observation. Further studies are needed to continue to improve risk stratification and more appropriately balance the concerns of over or under-treatment. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e265 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Martin Washington, DC More articles by this author Muhammad Iqbal Washington, DC More articles by this author Bruce Sprague Washington, DC More articles by this author H. Gil Rushton Washington, DC More articles by this author Craig Peters Washington, DC More articles by this author Hans Pohl Washington, DC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Acute 99mTc DMSA Scan Predicts Dilating Vesicoureteral Reflux in Young Children With a First Febrile Urinary Tract Infection

This study aimed to examine the ability of acute (99m)Tc DMSA scan for predicting dilating (grades III-V) vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children aged 2 years or younger. All children underwent ultrasonography (US), (99m)Tc DMSA scan, and voiding cystourethrography. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and receiver operating characteristic curves were performed to assess the diagnostic accuracy for predicting dilating VUR. Follow-up scan was performed at least 6 months after the acute infection to evaluate the presence of renal scarring (RS) or new scars. Of the 473 children analyzed (289 boys and 184 girls; median age, 5 months), 282 (59.6%) had abnormal acute (99m)Tc DMSA scan findings. There was VUR in 153 children (32.3%), whereas 95 (20.1%) had dilating VUR. The sensitivity and negative predictive value in predicting dilating VUR were 95.8% and 97.9%, respectively, for (99m)Tc DMSA and 97.9% and 98.6%, respectively, for combined US and (99m)Tc DMSA, whereas the positive and negative likelihood ratios were 1.90 and 0.08, respectively, for (99m)Tc DMSA and 1.57 and 0.06, respectively, for combined studies. On multivariate analysis, dilating VUR was a predictor for developing RS and new scars. Our results reveal the usefulness of acute (99m)Tc DMSA scan for predicting dilating VUR in children with a first febrile urinary tract infection. A voiding cystourethrography is indicated in only children with abnormalities found on a (99m)Tc DMSA and/or a US. The presence of dilating VUR predisposes to developing RS and new scars.

Renal DMSA scan morphology analysis using undecimated wavelet transform and isocontours

Signal and image processing tools open up opportunities to develop modules that can be interesting for supporting clinical decisions. In this paper, the aim is to develop an algorithm for providing better insight into renal scintigraphy scans using sparse transform such as discrete wavelet transform and isocontours. Renal 99mTc–DMSA scintigraphy scans are widely accepted as the most sensitive method for evaluating renal lesions and parenchymal damage like renal scars. An approach for improving DMSA scan analysis and regions of interest is presented from the aspect of visual inspection and relevant morphology information retrieval. For the purpose of testing archived scans are considered.

Results of Treatment of Grades IV and V Vesicoureteral Reflux with Endoscopic Injection of Polyacrylate Polyalcohol Copolymer

Purpose: Here we report the results of a review of a prospectively maintained database of the use polyacrylate polyalcohol copolymer (PPC) injection to correct grades IV and V VUR.Materials and Methods: All children with grades IV and V primary VUR that presented with febrile urinary tract infection while on prophylaxis, in a 3-year period, were treated with a sub-ureteral injection of PPC. Institutional ethical approval was obtained. Exclusion criteria were incomplete bladder emptying documented on videourodynamic study, ureteral duplication, paraureteral diverticula, and poor ureteral emptying observed during fluoroscopy and previous open surgical or endoscopic treatment. Pre- and post-operative evaluation included urinalysis, renal and bladder ultrasonography, DMSA scan, and videourodynamic studies.Results: Thirty-three children [36 renal units (RU)] were included with a median age of 57 months (range 7–108). There were 18 boys and 15 girls. Thirty RU had grade IV and 6 grade V VUR. Median follow-up time was 32 months (range 7–58). Reflux was cured in 32/36 RU with the first injection, but another two patients were reimplanted because of dilatation. Complications included early urinary tract infection in seven children, transient lower urinary tract symptoms in five children. Progressive ureteral dilatation was noted in four children and was treated with insertion of a double J stent. Two of these children eventually required an ureteroneocystostomy.Conclusion: The use of PPC to treat grades IV and V vesicoureteral reflux in young children has an overall success rate of 83.3%. Persistent ureteral dilatation was present in 11% associated with high injection volume. Future studies will attempt to maintain a high success rate reducing the volume of injection and the incidence of dilatation.

Vesicoureteral reflux: Endoscopic therapy and impact on health related quality of life

Aim:To evaluate the health related quality of life (HRQOL) after endoscopic injection treatment for vesico ureteral reflux (VUR) in children.Materials and Methods:Fifty four children received treatment and were prospectively evaluated for their quality of life scores, according to resolution of reflux on cystograms and status of renal scars.Results:Of the 81 refluxing units, 72 (89%) had resolution of reflux whereas 9 (11%) did not resolve. The total average QOL was higher for the patients in the resolved group as compared to the non resolved group. Comparison of pre and post procedure renal DMSA scans in 44 patients showed status quo in 26, regression of scars in six, progression in two and formation of new scars in 6. The total increase in HRQOL was highest in regression group (67.91), and lowest in progression group (36.45).Conclusions:Successful endoscopic treatment of VUR is associated with improved quality of life, as indicated by higher HRQOL scores in the resolved group.

DMSA scan: Interpretation is more important than doing the test!

DMSA scan: Interpretation is more important than doing the test!

La procalcitonine : un marqueur utile pour l’enfant présentant une infection urinaire

Urinary tract infections (UTIs) are one of the most common sources of bacterial infections among young febrile children. Accurate diagnosis of acute pyelonephritis (APN) and vesico-ureteral reflux (VUR) are important because of their association with renal scarring, sometimes leading to long-term complications. However, the gold standard examinations are either a DMSA scan for APN and scarring, or cystography for VUR, but both present limitations (feasibility, pain, cost, etc.). Procalcitonin, a reliable marker of bacterial infections, was demonstrated to be a good predictor of renal parenchymal involvement in the acute phase and in late renal scars, as well as of high-grade VUR. These findings need further broad validations and impact studies before being implemented into daily practice. However, procalcitonin may play a role in the complex and still debated picture of which examination should be performed after UTI in children.

Successful En Bloc Donation after Circulatory Death (DCD) Renal Transplant Into a Paediatric Recipient

Introduction: We report a case and five month follow-up data of a fifteen year-old African female who presented with end stage renal disease secondary to bilateral renal dysplasia aged 13 years and subsequently received a paediatric en bloc donation after circulatory death (DCD) renal transplant. Methods: A retrospective case-note review was performed, including clinical assessment, post-transplantation complications and renal growth by serial ultrasound measurements. Results: The recipient (15y, weight 55kg, CMV and EBV positive) received an en bloc DCD transplant (HLA mismatch 1,1,1) from a 23-month old who had died as a result of an intra-cerebral haemorrhage. The kidneys were transplanted en bloc into the right iliac fossa, the donor aorta and vena cava being anastomosed onto the recipient's common iliac artery and vein, with the ureters connected to the bladder and ureteric stents left in-situ. Prophylactic anticoagulation with subcutaneous heparin was given for two weeks. There were no surgical complications and no delayed graft function (plasma creatinine falling from 767μmol/l to 110μmol/l by day 6). Initial immunosuppression was prednisolone, azathioprine and tacrolimus. On day 11 she developed new-onset diabetes after transplant and commenced insulin. Prednisolone was weaned more rapidly with conversion of tacrolimus to ciclosporin. She had renal allograft dysfunction at six weeks (plasma creatinine rose from 100μmol/l to 178μmol/l). A renal transplant biopsy revealed grade 1b acute T-cell mediated rejection, which was successfully treated with intravenous methylprednisolone and conversion of azathioprine to mycophenolate mofetil. Despite a fall in the plasma creatinine back to baseline it increased again at two months. A repeat renal biopsy showed no significant rejection. Her plasma creatinine has since remained stable, however, due to side-effects of ciclosporin, she was converted back to tacrolimus. During the follow-up period, serial ultrasounds have shown progressive renal growth with the superiorly positioned kidney increasing in length from 73 to 93mm and the inferiorly positioned kidney increasing from 74mm to 101mm over four months (see figure). A DMSA scan showed no evidence of focal scarring in either kidney.Figure: [Growth of en bloc transplant kidneys]To date at five months follow up despite the complications of an acute rejection episode and developing new onset diabetes after transplantation, the recipient is well, is normotensive without proteinuria, has undetected viral loads for CMV, EBV and BK PCR DNA and an estimated glomerular filtration rate (eGFR) of 65mls/min/1.73m2. Conclusion: We report the successful outcome of transplanting en bloc DCD kidneys from a donor under two years of age into a fifteen year-old child. At present her transplant kidneys continue to demonstrate linear growth, which may account for her recently improved eGFR.

1204 Utility of Serum Procalcitonin to Predict Renal Scars in Infant with Febrile Urinary Tract Infection

Background and AimsThe aim of this study was to evaluate the usefulness of Procalcitonin(PCT) as a marker for renal scars in infants with a first febrile urinary tract infection(UTI).DMSA scintigraphy,...

740 Duplication of the Sox3 Gene in a Sry Negative 46, XX Male

Case presentationAn 11 old patient with hypoplasia of the right kidney and hypospadias was found to be SRY negative, 46, XX. His parents and younger sister were healthy. His intelligence...

383 A Rapid Blood Ngal Assay for Detection of Renal Cortical Defect in Infants with Febrile UTI: a Prospective Study

Background and AimsInfants with renal cortical defect due to acute pyelonephritis (APN) may be associated with an increased risk of progressive kidney damage. Neutrophil gelatinase-associated lipocalin (NGAL) is produced and...

Identifying Children with Vesicoureteral Reflux: A Comparison of 2 Approaches

Various screening approaches have been proposed to identify the subgroup of children with urinary tract infection who have vesicoureteral reflux. However, few studies have compared the sensitivity of screening approaches in a representative population of young children. We compared the sensitivities of the top-down ((99m)technetium dimercaptosuccinic acid renal scan to screen) and biomarker based (C-reactive protein level at presentation) approaches in identifying children with vesicoureteral reflux. We calculated the sensitivity of the 2 screening approaches in detecting vesicoureteral reflux and subsequently high grade (III or greater) vesicoureteral reflux in children. The top-down and C-reactive protein based approaches missed 33% and 29% of cases of high grade vesicoureteral reflux, respectively. The sensitivity of the top-down approach for detecting high grade vesicoureteral reflux was lower than previously reported. Further study of novel methods to identify children at risk for renal scarring is warranted.

The incidence of urinary tract infection after open anti-reflux surgery for primary vesicoureteral reflux: Early and long-term follow up

ObjectivesControversy exists regarding the benefit of open anti-reflux surgery (OS) in reducing the incidence of urinary tract infection (UTI). We, therefore, reviewed our short and long term data in children who have undergone OS. Methods153 children (131F, 22M; ages 2–16 yrs, mean 8 yrs) underwent OS from 1990 to 2008. Reasons for presentation were UTI-131; sibling survey-19; prenatal hydronephrosis-3. Major reasons for OS were: breakthrough UTI-74 (48%), high grade (IV or V)-49 (32%), poor compliance with prophylaxis-15 (10%). Of 153 pre-operative DMSA scans, 60 (39%) had defects. Post-operative studies were performed 6 months after surgery and 151 (99%) had negative voiding cystourethrograms (VCUG's). All underwent urine cultures 6 months post-op and prophylaxis was stopped. 56 (37%) were later contacted at an average 7 yrs post-op (range: 2–13 yrs). Results23 (15% of 153 followed short term, 40% of 56 followed long term)–20F, 3M–had non-febrile UTI's (nfUTI's) and one girl (0.6%) had a febrile UTI (fUTI). Of those who had nfUTI's 7 (30%) had high grade reflux and 16 (70%) had pre-op breakthrough UTI's. 11 (48%) had DMSA scans with defects. 2 had UTI's within 1 year after a negative VCUG and 21 had UTI's later (1–8 yrs). 1 girl had a fUTI 1 month after a negative VCUG. ConclusionsSuccessful OS effectively eliminates fUTI. Families should be counseled that nfUTI may occur many years after surgery, especially in girls with a history of breakthrough UTI and renal scarring.

99mTc-DMSA (V) in Evaluation of Osteosarcoma: Comparative Studies with 18F-FDG PET/CT in Detection of Primary and Malignant Lesions

To evaluate the role of 99mTc-DMSA (V) and [18F]FDG PET-CT in management of patients with osteosarcoma, 22 patients were included in our study. All patients underwent both 99mTc-DMSA (V) and whole-body [18F]FDG PET-CT scans within an interval of 1 week. 555–740 MBq of 99mTc-DMSA (V) was injected i.v. the whole-body planar, SPECT images of primary site and chest were performed after 3-4 hours. [18F]FDG PET-CT images were obtained 60 minutes after i.v. injection of 370 MBq of F-18 FDG. Both FDG PET-CT (mean SUVmax = 7.1) and DMSA (V) scans showed abnormal uptake at primary site in all the 22 patients (100% sensitivity for both). Whole-body PET-CT detected metastasis in 11 pts (lung mets in 10 and lung + bone mets in 1 patient). Whole-body planar DMSA (V) and SPECT detected bone metastasis in one patient, lung mets in 7 patients and LN in 1 patient. HRCT of chest confirmed lung mets in 10 patients and inflammatory lesion in one patient. 7 patients positive for mets on DMSA (V) scan had higher uptake in lung lesions as compared to FDG uptake on PET-CT. Three patients who did not show any DMSA uptake had subcentimeter lung nodule. Resuts of both 99mTc-DMSA (V) (whole-body planar and SPECT imaging) and [18F]FDG PET-CT were comparable in evaluation of primary site lesions and metastatic lesions greater than 1 cm. Though 99mTc-DMSA (V) had higher uptake in the lesions as compared to [18F]FDG PET-CT, the only advantage [18F]FDG PET-CT had was that it could also detect subcentimeter lesions.

DMSA scanning following UTI; are there changes after nice guideline introduction?

Aims NICE guideline CG54 (August 2007) recommends DMSA scan in children under 3 years with recurrent and/or atypical UTI and for all children with recurrent UTI. Prior to this, most children under five years with a proven UTI underwent a DMSA scan (Royal College of Physicians guideline, 1991). We aimed to assess the impact of the introduction of NICE guideline 54 in terms of DMSA scan rate, indication and results following UTI in children. Methods All children (under 16 year) who had a DMSA scan following UTI in 2007 (Jan-July) prior to the introduction of the NICE guidelines were identified, and compared with those undergoing DMSA scanning in 2010 (Jan-Dec). Cases with no proven UTI, previously known anatomical urinary tract abnormalities or other indications were excluded. Results We compared cases from 2007 (n=39) and 2010 (n=26), with no significant difference in terms of sex (p=0.903) or age distribution (p=0.812). The monthly scan rate reduced significantly from an average of 6.5 scans in 2007 to 2.2 scans in 2010 (p Conclusion Our results suggest that prior to the introduction of the NICE guideline, children were being over investigated with DMSA scans, with the associated implications of radiation from isotope exposure, child/parental stress and financial implications. We have significantly reduced the number and rate of DMSA scans in our unit following UTI. Results demonstrate a tendency towards a higher positive scan rate. Importantly, all those scans which would no longer be indicated were normal suggesting that the reduction in DMSA scans is unlikely to lead to missing significant pathology.

Successful paediatric en bloc renal transplant into a 15 year-old child: a tale of two kidneys

<h3>Aims</h3> We report a case and follow-up data of a 15 year-old black African female who presented with end stage renal disease secondary to dysplasia aged 13 years and subsequently received an en-bloc renal transplant two years later. <h3>Methods</h3> A retrospective case-note and laboratory results review was performed, including clinical assessment, post-transplantation complications, results and renal growth. <h3>Results</h3> The recipient (15 year, weight 55 Kg, CMV and EBV positive) received an en bloc donation after cardiac death (DCD) transplant (HLA mismatch 111) from a 23 month old who9d suffered an intra-cerebral bleed. The kidneys were transplanted into the right iliac fossa, the donor aorta and vena cava being anastomosed onto the common iliac artery and vein, with the ureters connected to the bladder with ureteric stents in-situ. Prophylactic anticoagulation with subcutaneous heparin was given for two weeks. There were no surgical complications and no delayed primary function (creatinine falling to 110 umol/L by day 6). Initial immunosuppression was prednisolone, azathioprine and tacrolimus. On day 11 new-onset diabetes after transplant was diagnosed. She commenced insulin. Prednisone was weaned more rapidly, tacrolimus stopped and ciclosporin A introduced. By 6 weeks follow-up the creatinine rose above its baseline of 100 umol/L to 178 umol/L. A renal biopsy revealed grade 1b acute T cell mediated rejection, treated with methylprednisolone and mycophenolate mofetil. Despite a fall in the creatinine back to baseline it increased again at 2 months with a concurrent renal biopsy showed no significant rejection. To date her creatinine has remained stable since though due to side effects of ciclosporin, she restarted tacrolimus with good diabetic control. During the follow-up period, serial ultrasounds have shown progressive renal growth with the superiorly positioned kidney increasing in length from 73 to 92 mm and the inferiorly positioned kidney increasing from 74 mm to 91 mm over three months. A DMSA scan showed no evidence of focal scarring in either kidney. <h3>Conclusions</h3> At three-month follow-up despite the complications of a rejection episode and developing diabetes, the recipient is well, normotensive without proteinuria, viral loads for CMV, EBV and BK virus remain undetected and she has an eGFR of 55 ml/min/1.73 m². Her transplant kidneys continue to demonstrate linear growth.

Antenatal detection of fetuses with renal pelvic dilatation and their 6 months outcomes at surrey and Sussex healthcare NHS Trust

Antenatally diagnosed urinary tract anomalies form approximately 20% of fetal malformations. Renal pelvic dilatation forms 2-3% cases.Embryologically, the renal organogenesis is complex involving multitude of pathologic factors. Obstruction to urinary...

Comparative study of kidney affection in SLE patients with and without antiphospholipid syndrome

Aim of the workTo evaluate the incidence, clinical associations and outcome of APS nephropathy in SLE patients with 2ry APS. Patients and methodsWe studied 64 female SLE patients with nephritis; 32 of them had 2ry APS (group 1) and the rest without 2ry APS (group 2). Demographic, clinical and serological data were prospectively evaluated. Systemic lupus erythematosus disease activity index (SLEDAI) and Systemic Lupus International Collaboration Clinics/ACR damage index (SLICC) were assessed. Renal duplex, renal 99mTc-dimercaptosuccinic) scan (DMSA scan) and renal magnetic resonance angiography (MRA) were all used to detect renal vascular affection. ResultsThere were statistically significant differences between the two examined groups regarding damage index (p=0.000), hypertension (p=0.02), thrombocytopenia (p=0.000), ↓LDL (p=0.008), ↓C3 (p=0.01) and TMA (p=0.04). In group 1: MR angiography detected 7 patients with RAS: 5 patients with renal artery thrombosis that showed a significant association with TMA and proteinuria (p=0.002, p=0.004: p<0.001, p=0.02, respectively). Patients with RAS had ↑DBP, ↑s.creatinine and ↑TGs (p=0.004, p=0.005 and p=0.0003, respectively). Renal DMSA detected 6 patients with cortical scar which showed a significant association with TMA, proteinuria, livedoreticularis and arthritis (p=0.001, p=0.01, p=0.04 and p=0.03, respectively) those patients had ↑DBP and ↑RI (p=0.000 and p=0.006, respectively). ConclusionaPL testing should become a routine investigation in patients evaluated for RAS or renal infarctions especially with hypertension and unexplainable deteriorating renal function. To confirm our results we propose that larger scale, multicentre studies with longer evaluation periods.

Cystographie isotopique indirecte couplée à la scintigraphie rénale corticale et détection des reflux vésicorénaux chez les nourrissons et les enfants atteints de pyélonéphrite

Vesico-uretero-renal reflux (VRR) and urinary tract infection are closely linked. Without any treatment, reflux nephropathy, hypertension and renal dysfunction are very often encountered. That is why a precocious and reliable diagnosis of RVR should be made. Our retrospective study included 33 infants and children suffering from acute pyelonephritis (APN). They were explored by both 99mTc-MAG3 indirect isotopic cystography (IIC), 99mTc-DMSA cortical renal scintigraphy performed on the same day, and radiological retrograde cystography (RRC). A VRR was expected on the same side than the pyelonephritic kidney. Results from IIC versus RRC and versus renal cortical acute pyelonephritis lesions, which were proved by the “gold standard” DMSA scan, were obtained. IIC detected a same-sided VRR in 52% and CRR in 33% of our patients. Some of them had bilateral lesions. IIC detected an homolateral VRR in 59% instead of 38% with RRC (P<0.05). IIC is a physiological noninvasive examination with a convenient sensitivity and dosimetry to search a VRR. Moreover, it gives in the same time interesting functional information on the kidneys and the urinary tract. Each of these characteristics can be favorably compared with RRC.