Micturating Cystourethrography Research Articles

Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI

To evaluate the accuracy of an acute (99m)Tc-dimercaptosuccinic acid (DMSA) scan in predicting dilating vesicoureteral reflux (VUR) among young children with a febrile urinary tract infection (UTI). The medical records of children (≤ 2 years of age), presenting with febrile UTI between January 2000 and December 2011, were retrospectively reviewed. A total of 523 children were included in this study, of whom 397 children (75.9%) had abnormal DMSA results and 178 children (34.0%) were identified as VUR on micturating cystourethrography (MCU). Among all the patients, the number of children with dilating VUR was 151 (28.9%). The rate of abnormal results on DMSA for the dilating VUR group was significantly higher than the rates for the non-VUR and low-grade VUR groups (P < .01). In the <6 months age group and ≥ 6 months age group, the sensitivities of DMSA in predicting dilating VUR were 96.15% and 100.0%, respectively, the negative predictive values were 97.26% and 100.0%, respectively, and the negative likelihood ratios were 0.0911 and 0.0000, respectively. For children ≤ 2 years of age with a febrile UTI, an acute DMSA scan is valuable in the exclusion of dilating VUR. The likelihood of the presence of dilating VUR on MCU is rather low when the result of DMSA is negative. DMSA should be conducted to assess the need for an MCU.

Evaluation of radiation dose to pediatric patients during certain special procedures

This study was intended to measure pediatric entrance surface air kerma (ESAK) and effective dose during micturating cystourethrography (MCU), intravenous urography (IVU) and barium studies (barium meal, enema, and swallow) and to propose a local diagnostic reference level (DRL). ESAK was measured for patients using calibrated thermoluminescent dosimeters (TLDs, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 236 special pediatric procedures were investigated. 21.7% of the sample comprised barium procedures, 18.6% were MCU procedures while 59.5% of the sample were IVU procedures. The mean ESAK measurements (mGy) were 2.1±0.8, 3.0±23 and 1.2±0.2 for barium meal, enema and swallow in the same order. The mean patient dose for IVU procedures was 12.4±8.7mGy per procedure and the mean patient dose per MCU procedure was 5.8±7mGy. Local DRLs were proposed for all procedures. The patient doses in this study are within the reported values, suggesting that pediatric patients are adequately protected.

Verification of radiation dose calculations during paediatric cystourethrography examinations using MCNP5 and PCXMC 2.0 Monte Carlo codes

The estimation of the radiological risk in the case of children is of particular importance due to their enhanced radiosensitivity when compared with that of adult patients. The purpose of this study is to estimate the organ and effective doses of paediatric patients undergoing micturating cystourethrography examinations. Since direct measurements of the dose in each organ are very difficult, dose-area products of 90 patients undergoing cystourethrography examinations were recorded and used with two Monte Carlo codes, MCNP5 and PCXMC2.0, to assess the organ doses in these procedures. The organs receiving the highest radiation doses were the urinary bladder (ranging from 1.9 mSv in the newborn to 4.7 mSv in a 5-y old patient) and the large intestines (ranging from 1.5 mSv in the newborn to 3.1 mSv in the 5-y old patient). For all ages the main contributors to the total organ or effective doses are the fluoroscopy projections compared with the radiographs. There was a reasonable agreement between the dose estimates provided by PCXMC v2.0 and MCNP5 for most of the organs considered in this study. In special cases, there were systematic disagreements in organ doses such as in the skeleton, gonads and oesophagus due to the anatomical differences between patient anatomic models employed by the two codes.

Detecting reflux: does ureteric jet Doppler waveform have a role?

Vesicoureteral reflux (VUR) has a prevalence of 30-40 % post-febrile urinary tract infection (UTI). If not detected early and treated, renal scarring, hypertension, and renal failure may occur. Micturating cystourethrography (MCU) is an invasive procedure associated with radiation exposure. Hence, this study aimed at evaluating the utility of ureteric jet Doppler waveform (UJDW) as a screening tool in detecting VUR, and at assessing the feasibility of performing it in children aged 2-4 years. Any child 2-18 years old who needed an MCU was included. Exclusion criteria were active UTI, indwelling catheter, and inability to drink the required amount of fluid. The UJDW was performed prior to the MCU. One hundred eighty-two ureteric units were analyzed. Sensitivity and specificity of UJDW in detecting VUR was 80.3 and 87.9 %. Twenty-three children (45 ureteric units), aged 2-4 years were compared with 73 children (137 ureteric units), aged 5-18 years. Sensitivity and specificity of UJDW in detecting VUR in 2-4 years was 77.3 and 91.3 %, respectively; while in children ≥5 years, it was 81.8 and 87.1 %, respectively. UJDW has a uniformly high specificity regardless of age or etiological groups, making it a good tool for follow-up. UJDW is a feasible technique, even in children aged 2-4 years.

DISTAL URETERAL STUMP: CASE REPORT

Introdution. Distal Ureteral Stump is a residual ureter after total or partial nephrectomy. It is a rare complication and it also appears many years after surgery. Majority of patients are asymptomatic but Literature reports patients with recurrent bacteriuria or haematuria, empyema, stones and tumors (transitional-cell carcinoma or renal-cell carcinoma). We present one case of diseased ureteral stump and surgical strategy. Case Report. We report a case of a patient subjected to retroperitoneoscopic total nephrectomy when he was seven months old for sympthomatic right vesico-ureteral reflux of IV grade and associated renal hypoplasia. These patient presented recurrent urinary infections after 3 years from the surgery and for this reason we performed voiding micturating cystourethrography who revealed the presence of urinary reflux in the DUS. Because of this surgical removal of stump was necessary and during 2 months follow-up was normal and there weren&rsquo;t surgical complications or UTI. Discussion. Distal Ureteral Stump is a rare complication but possible after nephrectomy and it is due to partial excision of ureter in the distal portion. Recurrent urinary infections are a usefull signal to subspect the presence of DUS and they are due to persistent reflux of urine and dysfunctional voiding (reservoir) resulting in stasis and infections. Therefore in all patients subjected to total or partial nephrectomy with recurrent urinary infections also after years, the pres- ence of DUS should always be suspected and radiological investigation must be performed for accurate management.

DISTAL URETERAL STUMP : CASE REPORT

Introdution. Distal Ureteral Stump is a residual ureter after total or partial nephrectomy. It is a rare complication and it also appears many years after surgery. Majority of patients are asymptomatic but Literature reports patients with recurrent bacteriuria or haematuria, empyema, stones and tumors (transitional-cell carcinoma or renal-cell carcinoma). We present one case of diseased ureteral stump and surgical strategy. Case Report. We report a case of a patient subjected to retroperitoneoscopic total nephrectomy when he was seven months old for sympthomatic right vesico-ureteral reflux of IV grade and associated renal hypoplasia. These patient presented recurrent urinary infections after 3 years from the surgery and for this reason we performed voiding micturating cystourethrography who revealed the presence of urinary reflux in the DUS. Because of this surgical removal of stump was necessary and during 2 months follow-up was normal and there weren’t surgical complications or UTI. Discussion. Distal Ureteral Stump is a rare complication but possible after nephrectomy and it is due to partial excision of ureter in the distal portion. Recurrent urinary infections are a usefull signal to subspect the presence of DUS and they are due to persistent reflux of urine and dysfunctional voiding (reservoir) resulting in stasis and infections. Therefore in all patients subjected to total or partial nephrectomy with recurrent urinary infections also after years, the pres- ence of DUS should always be suspected and radiological investigation must be performed for accurate management.

Analysis of the prognosis and clinical factors in primary vesicoureteral reflux patients

To analyze the relationship between the prognosis and clinical factors of primary vesicoureteral reflux (VUR) patients under the condition of non-surgical treatment. The medical records of the patients who were diagnosed as VUR by micturating cystourethrography (MCU) from January 2000 to December 2009 in Children's Hospital of Fudan University underwent non-surgical treatment, and followed up for more than one year then had repeated MCU, were retrospectively reviewed. A total of 73 children (30 boys, 43 girls) were included in this study. The percentage of mild reflux (grade I-II) was 19.2% (14/73), that of moderate reflux (grade III) was 53.4% (39/73), and that of severe reflux (grade IV-V) was 27.4% (20/73). Among 73 patients, 27 (37.0%) patients were found to have renal damage. The average interval of repeated MCU was (1.29 ± 0.40) years (1 - 2 years). After follow-up, it was found that the reflux grade was relieved in 41 (56.2%) patients, of whom 27 (37.0%) patients achieved complete resolution, 32 (43.8%) patients did not have remission in reflux grade, of whom 13 (17.8%) patients had worsened reflux grade. Logistic regression analysis showed that VUR patients with renal damage at initial diagnosis was an important clinical factor to affect reflux remission (P = 0.000), complete resolving (P = 0.008) and result in worsening (P = 0.002). A certain proportion of primary VUR patients could get reflux grade self-resolution, it was also quite common in severe VUR patients. VUR patients with renal damage at initial diagnosis was an important clinical factor affecting the reflux grade prognosis. Mild and moderate VUR patients with renal damage were at risk of worsening. VUR patients with high reflux grade had normal renal status could still get remission or even disappearance of VUR. But severe VUR patients with renal damage were still recommended to receive surgical therapy.

Comparison of open and laparoscopic pneumovesical approaches for ureteral reimplautation

Objective To compare the clinical results of the ureteral reimplantation with the traditional open approach and laparcocopic pneumovesical approach. Methods A retrospective review of 108 patients who underwent ureteral reimplantation from December 2004 to October 2010 was conducted.The patients were divided into open and pneumovesical groups according to the surgical approach.Perioperative results were compared between the two groups in terms of operative time,postoperative intravenous antibiotics duration,catheterization duration,postoperative stay,average total cost and surgical cost,respectively.And the pneumovesical group was divided into two stages by time,compared the operative time of the two stages and between the later stage and the open group. Results The postoperative hospital stay of pneumovesical group was shorter than the open group (6.8 ± 1.9 d and 8.9 ± 2.9 d,P =0.002 ).For catheterization duration,the pneumovesical group was shorter than the open group as well (5.2 ± 1.2 d and 6.2 ±2.2 d,P=0.057).For the postoperative intravenous antibiotics duration,the pneumovesical group was 5.0 ± 1.3 h,the open group was 5.4 ±1.6 h (P =0.159).For the total cost,the pneumovesical group was 16 067.9 ±4 295.8 RMB,the open group was 15 617.7 ± 5 486.5 R MB (P =0.168).For the surgical cost,the pneumovesical group was 9369.4 ± 1366.6 RMB,the open group was 7397.9 ± 1797.3 RMB ( P =0.083 ).Operative duration of the pneumovesical group and open group were 3.2 ± 1.1 h and 2.3 ± 1.1 h ( P =0.003).For pneumovesical group,the mean operative durations of the two stages were 3.6 h and 2.8 h (P =0.286).And the later stage of pneumovesical group was a little longer than the open group,but no significant difference ( P =0.234 ).No major complication was found in the 2 groups during the operative time and the postoperative hospital stay.Twenty-four patients (38 ureters) of the pneumovesical group were followed up with micturating cystourethrography ( MCU),ureterovesical reflux recurred in 3 patients.Two patients changed from grade Ⅲ to grade Ⅰ and 1 patient changed from grade Ⅴ to grade Ⅲ after the surgery.Five patients (9 ureters) of the open group were followed up,1 patient found bladder diverticulum; 1 patient found ureteral stricture 6 months after the surgery and got improved after secondary ureteral relimplantation surgery. Conclusions The pneumovesical approach is shorter than the open group in postoperative hospital stay and catheterization reserved duration.The pneumovesical approach is a safe and effective option for ureteral reimplantation. Key words: Ureteral reimplantation ; Vesicoareteral reflux; Pneumovesical ; Retrospective studies

Echocontrast cystosonography versus micturating cystourethrography in the detection of vesicoureteric reflux.

Purpose:To compare echocontrast cystosonography (ECS) using in-vivo agitated saline with fluoroscopic micturating cystourethrography (MCU) in the detection and grading of vesicoureteric reflux (VUR).Materials and methods:This was a prospective study of 25 children, who had MCU between 2007 and 2009. ECS was performed and findings documented prior to MCU. Baseline renal and bladder sonograms were obtained. The bladder was filled with normal saline followed by introduction of 10–20 mls of air to generate microbubbles. Detection of VUR was based on two sonographic criteria: (1) presence of microbubbles in the pelvicaliceal system (PCS), and (2) increase in dilatation of the PCS. VUR was graded as (1) Grade I: microbubbles seen in ureter only; (2) Grade II: microbubbles seen in non-dilated PCS; and (3) Grade III-V: microbubbles seen in dilated PCS. The ECS findings were compared using MCU as the gold standard.Results:Of the 50 kidney-ureter (K-U) units studied, ECS detected 9 of 10 K-U units with VUR on MCU. ECS did not detect a Grade II VUR. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for criterion 1 was 90%, 87.5%, 88%, 64.3% and 97%, respectively, compared to criterion 2 which was 70%, 90%, 86%, 64% and 92%, respectively. The grading of VUR was similar on both ECS and MCU except for one case.Conclusion:ECS using agitated saline was a sensitive technique for the detection of VUR. ECS grading was comparable with MCU grading of VUR.

985 Role of Dmsa Renal Scintigraphy in Children with Vesicoureteral Reflux

Objective: Urinary tract infection (UTI) is a common condition in children with vesicoureteral reflux (VUR), and may lead to renal damage. The aim of this study was to determine the incidence and pattern of abnormal scintigraphy findings in children with UTI and VUR. Patients and Methods: Data of 118 children who underwent micturating cystourethrography (MCU) and late Tc-99m dimercaptosuccinic acid (DMSA) scan were evaluated. Findings were categorized under the image appearance and relative kidney uptake (RKU) and related to the grade of VUR, sex and child's age. Results: MCU revealed VUR (78 unilateral and 40 bilateral) of grades I, II, III, IV and V in 2, 47, 35, 19 and 15 patients respectively. There were 52 children with normal and 66 with abnormal DMSA finding. Scarring rate was significantly associated with high grade VUR (p=0.0023) and male gender (p=0.0412). Bilateral scarring was shown exclusively in children with bilateral VUR. No significant difference was found between renal scarring and child's age in the same gender group. Poor kidney function was shown in 5 patients. Conclusion: Renal scarring highly correlated with grade of VUR. A strategy to perform MCU only on patients with abnormal DMSA finding is proposed.

Renal scintigraphy in children with vesicoureteral reflux

To determine the incidence and pattern of abnormal scintigraphy findings in children with UTI and VUR. Data of 118 children who underwent micturating cystourethrography (MCU) and late Tc-99m dimercaptosuccinic acid (DMSA) scan were evaluated. Findings were categorized under the image appearance and relative kidney uptake (RKU) and related to the grade of VUR, sex and child's age. MCU revealed VUR (78 unilateral and 40 bilateral) of grades I, II, III, IV and V in 2, 47, 35, 19 and 15 patients respectively. There were 52 children with normal and 66 with abnormal DMSA finding. Scarring rate was significantly associated with high grade VUR (p=0.0023) and male gender ( p=0.0412). Bilateral scarring was seen exclusively in children with bilateral VUR. No significant difference was found between renal scarring and child's age in the same gender group. Poor kidney function was shown in 5 patients. Renal scarring highly correlated with grade of VUR. A strategy to perform MCU only on patients with abnormal DMSA finding is proposed.

Radiological investigations following urinary tract infection: changes in Australian practice

Objective:To examine practice changes in the conduct of radiological investigations in Australia following urinary tract infection (UTI).Design:Observational study using data from the national Medicare database over the 15-year period July...

MRI in congenital duplication of urethra

Congenital urethral duplication is a rare anomaly, with less than 200 cases described in the literature. The investigations that are usually performed are micturating cystourethrography (MCU) and retrograde urethrography (RGU), which can diagnose the presence of duplication but cannot diagnose the precise relationship of the duplicated urethra with other pelvic structures. MRI, because of the excellent tissue contrast that it provides and its multiplanar ability, can demonstrate with precision, the size, shape and position of the two urethras. We describe below a case where MRI was able to show this exquisitely.

Clinical and Radiological Changes after use of Alpha-1 Blocker Therapy in Patients of Posterior Urethral Valve with Bladder Neck Hypertrophy

Background: We evaluated the effects of alpha-1 blocker therapy on clinical and radiological abnormalities in patients of posterior urethral valve with bladder neck hypertrophy.&#x0D; Materials and Methods: A total of 74 patients with posterior urethral valves were seen at our department between 2003 and 2007. Out of these 24 had radiological evidence of bladder neck hypertrophy. Those patients with bladder neck hypertrophy who were seen before June 2006 and did not receive alpha-1 blocker (prazocin) therapy after valve ablation were assigned to group 1 (n=10). Group 2 consisted of 14 age matched patients with bladder neck hypertrophy and comparable prognostic factors who received alpha-1 blocker therapy after valve ablation (n=14). Micturating cystourethrography (MCU) was done periodically and a novel method used to calculate bladder neck hypertrophy. Trends in symptoms and radiological changes were evaluated throughout follow-up.&#x0D; Results: Mean patient age at presentation was 3.02±2.68 years in group 1 and 3.12±3.4 years in group 2. Bladder neck hypertrophy decreased from 2.3±1.0 to 2.0±0.5 in a mean time of 52.0 (34-52) weeks in group 1 where as it decreased from 2.2±0.5 to 1.6±0.3 in a mean time of 32.0 (22-52) weeks. Symptomatically patients in group 2 who received alpha-1 blocker therapy after valve ablation were better and had quick resolution of bladder neck hypertrophy.&#x0D; Conclusions: Use of alpha-1 blocker therapy in patients of posterior urethral valve with bladder neck hypertrophy helps in quick resolution of bladder neck hypertrophy. J Med Sci 2009;12(1):3-7.

Imaging in Pediatric Urinary Tract Infection: A 9-Year Local Experience

Urinary tract infection (UTI) is a common disease entity in children, and a number of imaging options are offered for these patients. The purpose of our study was to retrospectively describe the (99m)Tc-labeled dimer captosuccinic acid (DMSA) renal scintigraphy, ultrasound, and micturating cystourethrography (MCU) findings over a 9-year period. All children younger than 10 years old who presented to a local hospital in Hong Kong between July 1, 1997, and June 30, 2006, with culture-confirmed UTI and who subsequently underwent DMSA scintigraphy, ultrasound, and MCU were identified. For the purpose of this study, patients with underlying major congenital urinary tract abnormalities were excluded. DMSA scintigraphy was regarded as the gold standard for the diagnosis of renal scarring. DMSA scintigraphy, ultrasound, and MCU findings and clinical outcomes were reviewed and analyzed. A total of 583 children were included in the study. Of these, 432 children (74.1%) had normal findings on ultrasound and on MCU. Only 13 children (3%) of this group had renal scarring as shown on DMSA scintigraphy. The overall negative predictive value (NPV) for excluding renal scarring of combined ultrasound and MCU reached 97%. The NPV was 97.7% in the subgroup of patients 0 to 2 years old. For children younger than 2 years with UTI in the absence of underlying major congenital urinary tract abnormalities, we recommend that DMSA scintigraphy may be withheld if findings on both ultrasound and MCU examinations are normal.

Role of magnetic resonance urography in diagnosis of duplex renal system: Our initial experience at a tertiary care institute

Aim:To determine diagnostic value of magnetic resonance urography in cases of duplex renal system.Method:Twenty cases between five month to nine years with suspected or known duplex renal system were evaluated by ultrasound (USG), micturating cystourethrography (MCU), intravenous urography (IVU) and magnetic resonance urography (MRU). The findings of these diagnostic imaging studies were then compared with each other and against the results of final diagnosis established at surgery.Results:Duplex renal system could be identified in two of these cases on USG, was diagnosed in four in IVU and could be diagnosed in all cases with MRU.Conclusion:MRU is superior and far accurate than IVU, MCU and USG in diagnosing duplex renal system.

Webbed Penis Associated With Urethral Duplication: A Case Report

An 18-month-old boy was admitted to our hospital due to the abnormal appearance of the external genitalia. The boy was born at full term after an uneventful pregnancy, and weighed 3400 g with a length of 51 cm and a head circumference of 35 cm. The patient’s history showed that his mother first noticed the abnormal external genitalia at birth, and this was confirmed by his father. After a period of time, his general practitioner referred him to our hospital for surgical treatment. The mother’s pregnancy was uncomplicated and there was no exposure to drugs, alcohol, or other known toxins. Physical examination showed a web of skin between the scrotum and the urethral surface of the penis, and proximal incomplete urethral duplication (Figs. 1A, B). There was no chordee. The excretory urography showed Type I incomplete urethral duplication (Fig. 2A). The results of micturating cystourethrography (MCU) (Fig. 2B) and other laboratory tests were normal. In the operation, the web was incised transversely and sutured vertically. Urethroplasty was performed to repair the incomplete urethral duplication. Circumcision was also performed. He had no problems in the 15 months following the operation.

Impact of micturating cystourethrography and DMSA renal scintigraphy on the investigation scheme in children with urinary tract infection

The relationships among urinary tract infection (UTI), vesicoureteral reflux (VUR), and permanent renal damage in children are not fully understood. The aim of this study was to evaluate the incidence of renal scarring in children with a history of UTI and to determine the change in the probability of permanent renal damage owing to the presence of VUR documented on micturating cystourethrography (MCU). We analyzed 201 children (400 renal units, two children with solitary kidney). Seventy-four boys and 127 girls (aged 7 months to 7 years, median 2.5 years) with culture verified UTI were referred for technetium-labeled dimercaptosuccinic (DMSA) renal scintigraphy 4-6 months after acute UTI. MCU was also performed mostly 1 month prior to DMSA. Statistical analysis was performed using chi2 test or Fisher's exact test. Likelihood ratio (LR) positive and negative, diagnostic odds ratio (DOR), and post-test probability of (no) disease were calculated for VUR on MCU versus scarring on DMSA. Vesicoureteral reflux was found in 158 (39.5%) kidneys, and evaluated as grades I, II, III, IV, and V in 3, 70, 43, 25, and 17 refluxing renal units (RRU), respectively. Permanent renal damage according to DMSA was seen in 15.2% (61/400) kidneys. Scarring was shown in 29.7% (47/158) of kidneys with VUR and in 5.8% (14/242) kidneys without VUR (P<0.0001). LR positive was 2.353 (95% CI 1.889, 2.865), LR negative 0.341 (95% CI 0.209, 0.523), and DOR 6.895 (95% CI 3.533, 14.093). Rate of scarring significantly increased with VUR of grades III, IV, and V. There was no significant difference in the incidence of scarring in kidneys without VUR and RRU with low-grade (I and II) VUR (P=0.306). The presence of VUR on MCU increased the chance of renal damage on DMSA by about 15%, whereas negative MCU increased the chance of no-renal involvement by 9%. Micturating cystourethrography should not be used as a first-line test to rule out the permanent renal damage owing to UTI. The priority of imaging strategy should be focused on early identification of renal lesions to prevent further deterioration.

Endoscopic Management of Adult Orthotopic Ureterocele and Associated Calculi with Holmium Laser: Experience with 16 Patients over 4 Years and Review of Literature

To retrospectively evaluate the safety and effectiveness of holmium laser endoscopic incision and laser lithotripsy in adults with orthotopic ureterocele and associated calculi. From May 2003 to August 2007 at our center, 16 adults underwent transurethral incision of an ureterocele and intracorporeal holmium laser lithotripsy for associated calculi. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition. Ureterocele was associated with a single system in 13 patients. Two patients had bilateral ureteroceles. Four patients had associated upper tract stones. The procedure was uneventful in all patients. The average postoperative hospital stay was 19.3 hours. All patients were stone free after the procedure. Eleven patients were available for follow-up at 3 and 6 months. None of these patients had any evidence of residual ureterocele and/or hydronephrosis when evaluated with intravenous urography at 3 months. Micturating cystourethrography (MCU) at 3 months revealed low-grade vesicoureteral reflux (VUR) in four patients; no reflux was found with MCU at 6 months. Laser endoscopic management of adult orthotopic ureterocele and associated calculi effectively decompressed ureterocele and removed stones in all patients without any significant postoperative morbidity. Low-grade VUR that may occur postoperatively resolved at 6 months. A literature review suggests that the ability of the holmium laser to manage both ureterocele and calculi simultaneously should make holmium laser management a procedure of choice at centers that possess the equipment.

Radiation dose measurement and risk estimation for paediatric patients undergoing micturating cystourethrography

Micturating cystourethrography (MCU) is considered to be the gold-standard method used to detect and grade vesicoureteric reflux (VUR) and show urethral and bladder abnormalities. It accounts for 30-50% of all fluoroscopic examinations in children. Therefore, it is crucial to define and optimize the radiation dose received by a child during MCU examination, taking into account that children have a higher risk of developing radiation-induced cancer than adults. This study aims to quantify and evaluate, by means of thermoluminescence dosimetry (TLD), the radiation dose to the newborn and paediatric populations undergoing MCU using fluoroscopic imaging. Evaluation of entrance surface dose (ESD), organ and surface dose to specific radiosensitive organs was carried out. Furthermore, the surface dose to the co-patient, i.e. individuals helping in the support, care and comfort of the children during the examination, was evaluated in order to estimate the level of risk. 52 patients with mean age of 0.36 years who had undergone MCU using digital fluoroscopy were studied. ESD, surface doses to thyroid, testes/ovaries and co-patients were measured with TLDs. MCU with digital equipment and fluoroscopy-captured image technique can reduce the radiation dose by approximately 50% while still obtaining the necessary diagnostic information. Radiographic exposures were made in cases of the presence of reflux or of the difficulty in evaluating a finding. The radiation surface doses to the thyroid and testes are relatively low, whereas the radiation dose to the co-patient is negligible. The risks associated with MCU for patients and co-patients are negligible. The results of this study provide baseline data to establish reference dose levels for MCU examination in very young patients.