sodium-pertechnetate-tc-99m and Vesico-Ureteral-Reflux

Reflux is often an important phenomenon in the urinary tract of a child, and many methods have been advocated to detect it. The single most sensitive, accurate, and efficient way currently available to detect and characterize reflux is direct VCUG under fluoroscopic control with the contrast material instilled through a urethral catheter. Nuclear cystography is the most efficient method for screening for reflux in appropriate situations, for making sure the reflux has disappeared after corrective surgery, and for following reflux that is likely to subside spontaneously.

Topics: Child; Contrast Media; Cystoscopy; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Ultrasonography; Urinary Catheterization; Urography; Vesico-Ureteral Reflux

Over the past 10 years new imaging and interventional techniques have drastically changed the ease and scope of urologic diagnosis and treatment. It is both rewarding and exciting to approach each clinical problem with a broad armamentarium of available studies, always seeking the most efficient and direct route to diagnosis. Similarly, radiologic interventional techniques are potentially applicable to a multitude of problems and should be innovatively considered in the urologic patient including patients in the pediatric age group.

Topics: Abscess; Child; Child, Preschool; Female; Humans; Hydronephrosis; Ileum; Infant; Iodohippuric Acid; Kidney; Kidney Diseases; Male; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed; Ultrasonography; Ureteral Obstruction; Urethra; Urinary Bladder; Urinary Calculi; Urinary Diversion; Urologic Diseases; Vesico-Ureteral Reflux

The aim of this study is to compare the results of direct radionuclide cystography (DRNC) and voiding cystourethrography (VCUG) in a group of children with a high suspicion of vesicoureteral reflux (VUR).. For this purpose, 25 children were studied with both VCUG and DRNC. Among 50 ureter units able to be compared 39 ureter units did not show any VUR on either study. Eleven ureter units (10 children) had VUR either on one study or on both (VCUG and DRNC). In the children who had VUR on either study, a dimercaptosuccinic acid scintigraphy (DMSA) was performed to determine their cortical function.. We identified the following four patterns: 1) Five ureter units (five children) read positive on DRNC who were negative on VCUG and four of these children had positive findings on DMSA; 2) Four ureter units (four children) read positive on VCUG who were negative on DRNC, and two of them had positive findings on DMSA; 3) Two ureters (one child) read positive in both studies and also had abnormal DMSA findings; 4) Thirty-nine ureter units read as negative on both studies.. Although the results of these two methods did not show a significant difference, DRNC offers a high sensitivity in the younger age group whereas VCUG seems to be more sensitive in the older age group. DRNC also offers continuous recording during the study, ease of assessment and lower radiation dose to the gonads, which makes it a preferable method for the initial diagnosis and follow-up of VUR.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Dimercaptosuccinic Acid; Urination; Vesico-Ureteral Reflux

Extra-renal pelvis (ERpel) is a common ultrasonographic finding among neonates who have undergone recurrent ultrasound examinations for a better definition of prenatal renal pelvic dilatation. This study tries to determine whether or not ERpel has important prognostic implications. Seventy-nine neonates (17 female) were examined. All had a diagnosis of prenatal renal pelvis dilatation, which was shown by postnatal ultrasound to be ERpel. Sixty ERpel neonates were examined 1.5 months to 2.5 months after the ultrasound (US) diagnosis by both Tc-99m diethylene triamine penta-acetic acid (DPTA) dynamic renal scanning and (99m)Tc-pertechnetate direct cystography. Clinical assessment, urine cultures and renal ultrasound follow-up were maintained for 2 years. The proportion of urinary tract infections (UTIs) in patients with ERpel was compared with that of the total neonatal and infantile population with normal US scans in the region of our hospital. Associated minor congenital malformations were found in 12 of 79 neonates (15.2%). Four had a family history of ERpel. Among 60 neonates who underwent renal scanning, 36 (60%) were found to have urinary retention in the collecting system. Another nine (15%) had vesico-ureteral (VU) reflux, of which seven had urinary retention. Fifteen (25%) showed normal isotope imaging. Urinary tract infection was diagnosed in 16 ERpel neonates in whom only one exhibited VU reflux (grade 2). The incidence of neonatal UTI in the ERpel group was more than that of either neonatal or infantile UTI in those with normal US scans in the local population (20.2% vs 1.2% and 4.3%, respectively). Fifty-three infants completed a 2-year follow-up. Repeat renal ultrasonography indicated that one infant (1.8%) had developed bilateral hydronephrosis, 12 (22.6%) had unchanged findings, 18 (40%) showed an improvement (decrease of ERpel width or resolution in one side) and, in 22 (41.5%) infants, the condition had resolved. No clinical or kidney function deterioration was observed. Seven patients (13.2%) each had one episode of UTI during the 2-year follow-up period; none of them had VU reflux. Neonatal ERpel is more frequent in male infants. It is associated with greater rates of minor congenital malformations, VU reflux and UTI than in the general population of the same ages. The increased UTI incidence is not attributed to VU reflux.

Topics: Abnormalities, Multiple; Female; Follow-Up Studies; Humans; Incidence; Infant, Newborn; Kidney Pelvis; Male; Radiography; Radionuclide Imaging; Radiopharmaceuticals; Sex Distribution; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pentetate; Ultrasonography; Urinary Bladder; Urinary Retention; Urinary Tract Infections; Vesico-Ureteral Reflux

We compared the accuracy of isotope cystography (IC) and fluoroscopic cystourethrography (FC) in detecting vesicoureteric reflux (VUR) in children. FC and IC were performed in 124 children, 56 boys and 68 girls, aged 1 month to 9.2 years (mean 2.1 years), admitted consecutively for suspected VUR over a 10-month period. VUR was diagnosed by one or both studies in 51 of 124 (41%) patients. The two methods were concordant for the detection of VUR in 84% of kidney-ureter units and in 93% for the detection or exclusion of severe VUR. IC detected VUR more accurately than FC, both when all grades of VUR were considered together (P=0.00001) and when only severe reflux was considered (P=0.004). VUR was missed by FC in 23 of 51 (45%) subjects. Of those 23, 12 had severe VUR detected on one side at least by IC. VUR was missed by IC in 3 subjects. IC is significantly more accurate than FC in the initial diagnosis of VUR, even of severe grade. IC is the method of choice for the first diagnosis of VUR. Boys with VUR diagnosed by IC also need FC to investigate for posterior urethral valves.

Topics: Chi-Square Distribution; Child; Child, Preschool; Female; Humans; Infant; Kidney; Male; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Ureter; Urography; Vesico-Ureteral Reflux

Topics: Child; Humans; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid; Urinary Bladder; Vesico-Ureteral Reflux

Topics: Adolescent; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Thyroid Gland; Urinary Bladder; Urinary Bladder, Neurogenic; Vesico-Ureteral Reflux

This study quantifies some of the outcome predictors in a group of children with primary vesicoureteral reflux who were initially managed medically.. We studied 133 patients with primary reflux for 7.1 +/- 2.2 yr. Direct vesicoureteral scintigraphy (DVS) was used to prospectively measure the absolute bladder volume at which reflux began and the maximum volume of urine refluxed into the ureters during the filling and voiding phases of their first two DVS studies. Findings were related to outcome as defined by spontaneous resolution or the eventual need for reconstructive surgery.. Medical management eventually failed in 35% of this sample. Patients who did not begin to reflux until their bladders had been filled to more than 60% total bladder capacity had a substantially smaller risk of surgery than those who began to reflux at smaller bladder volumes. Patients who refluxed a volume of urine back into their ureters that was less than about 2% of their total bladder capacity had a substantially smaller risk of surgery than those who refluxed more than 2%. The difference between groups was significant for both DVS variables (p < 0.001).. Quantitative DVS contributes to the assessment of prognosis in children with vesicoureteral reflux who are managed medically.

Topics: Child; Child, Preschool; Female; Humans; Logistic Models; Male; Predictive Value of Tests; Prognosis; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Treatment Outcome; Ureter; Urinary Bladder; Vesico-Ureteral Reflux

Voiding cystourethrography is widely used in children to detect vesicoureteral reflux disease. A case of radionuclide voiding cystourethrography is reported, where the initial location of the catheter tip in an open ureter ostium might have lead to erroneous interpretation. Recommendations for catheter technique and control of imaging in voiding cystourethrography are given.

Topics: Child; Female; Humans; Organotechnetium Compounds; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Catheterization; Vesico-Ureteral Reflux

A retrospective review comparing bladder absorption of pertechnetate and Tc-99m sulfur colloid from the augmented bladder was performed. Based upon the author's findings, the routine use of Tc-99m sulfur colloid in this patient population is recommended to prevent the erroneous diagnosis of vesicoureteral reflux and miscalculation of GFR due to the presence of background soft-tissue and blood activity.

Topics: Glomerular Filtration Rate; Humans; Meningomyelocele; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Urinary Bladder; Vesico-Ureteral Reflux

The familial nature of vesicoureteral reflux among siblings of patients with vesicoureteral reflux has been reported to be from 8% to 32%. These included both symptomatic and asymptomatic siblings. The incidence of vesicoureteral reflux in asymptomatic siblings, however, has not been studied extensively. Sixty asymptomatic siblings of patients known to have vesicoureteral reflux were studied with radionuclide voiding cystography. Their ages ranged from 2 months to 15 years (mean, 4.2 years). Vesicoureteral reflux was detected in 27 of 60 (45%) of the siblings. Vesicoureteral reflux was unilateral in 15 and bilateral in 12 of the siblings. Radionuclide cystography is more sensitive than radiographic cystography and results in a very low radiation dose to the patient. The gonadal dose with radionuclide cystography is only 1.0 to 2.0 mrads. Because of these features, radionuclide cystography is a nearly ideal technique for the diagnosis of vesicoureteral reflux in siblings of patients with known vesicoureteral reflux. All siblings (symptomatic or asymptomatic) of patients with known vesicoureteral reflux should have a screening radionuclide cystography.

Topics: Child; Child, Preschool; Female; Humans; Infant; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Bladder; Vesico-Ureteral Reflux

Recurrent pyelonephritic episodes in children with normal contrast cystograms pose a difficult management problem, since the lack of demonstrable reflux adversely affects the treatment. A total of 10 children with clinical symptoms of pyelonephritis in whom normal contrast cystograms had been performed properly subsequently had significant degrees of reflux detected by isotope cystography. These findings indicate that isotope cystography should be included in the evaluation of patients with pyelonephritis in whom reflux is not confirmed by conventional contrast medium techniques.

Topics: Adult; Child; Child, Preschool; Female; Humans; Pyelonephritis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Urinary Bladder; Urography; Vesico-Ureteral Reflux

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Male; Methods; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Pentetate; Vesico-Ureteral Reflux

Topics: Child; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Vesico-Ureteral Reflux

Video voiding cystourethrography in 47 patients was compared to 99mTc cystography performed suprapubically in 20 patients and 123I Hippuran renocystography performed in 43 patients. The degrees of reflux were equally distributed through the grades. 99mTc cystography was negative in 4 of 5 grade 2 refluxes and positive in 4 out of 5 grade 3-4 refluxes. Computerized dynamic tracings of the 123I renocystography showed an activity level increase over the kidneys of more than 1% of the bladder activity level in 47 units, 18 were equivocal and 21 negative. Grade 2 and 3 reflux found on the video VCU was refound on the renocystography. 24 false positives were found. It is concluded that 99mTc cystography performed as in our unit adds no further information to the diagnosis of reflux and that 123I renocystography diagnosing the more severe degrees of reflux may be a future method of non-invasive reflux control.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Iodohippuric Acid; Male; Radiography; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Television; Vesico-Ureteral Reflux

Nuclear cystography is recommended for the evaluation of vesicoureteral reflux because of its high sensitivity and its low radiation exposure. We encountered a potential source of false-positive studies in patients who have had an ileocecocystoplasty for bladder augmentation. This case presentation illustrates the findings in such a patient.

Topics: Cecum; Child; False Positive Reactions; Female; Humans; Ileum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Urinary Bladder; Vesico-Ureteral Reflux

Topics: Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Vesico-Ureteral Reflux