technetium-tc-99m-sulfur-colloid and Vesico-Ureteral-Reflux

Reflux grade predicts resolution and influences followup and treatment. Bladder pressure at the onset of reflux may reflect the ureterovesical junction competence. By combining simultaneous cystometry with nuclear cystography (nuclear cystometrogram) we determined bladder pressure at the onset of reflux.. Nuclear cystometrograms were performed in 40 children to determine bladder pressure at the onset of reflux, reflux volume and bladder capacity at the onset of reflux. The effect of bladder pressure and capacity at the onset of reflux was assessed with a reflux pressure volume index.. A weak inverse correlation existed between bladder pressure at the onset of reflux and a normalized volume of reflux (r = -0.32, p = 0.018). A stronger correlation existed between reflux pressure and bladder volume at reflux (r = 0.47, p = 0.0002). An inverse correlation of the reflux pressure-volume index and reflux volume was significant (r = -0.49, p = 0.0002) as was the correlation between bladder volume at reflux and amount of reflux (r = -0.47, p = 0.0003). The reflux pressure-volume index for patients with persistent reflux at followup (median 1.89) was significantly smaller than that for those without reflux (median = 8.71, p = 0.02). A difference existed in normalized bladder volume at reflux between resolved and persistent reflux (p = 0.003). No difference was detected with respect to reflux volume and resolution (p = 0.738).. A nuclear cystometrogram is no more invasive than a standard cystogram and permits determination of bladder pressure at the onset of reflux. Factors such as reflux pressure and bladder volume at reflux provide additional characterization of the ureterovesical junction and may help determine the prognosis for reflux resolution.

Topics: Administration, Intravesical; Child; Child, Preschool; Cystoscopy; Female; Follow-Up Studies; Humans; Hydrostatic Pressure; Male; Mathematical Computing; Prognosis; Radionuclide Imaging; Reference Values; Signal Processing, Computer-Assisted; Software; Technetium Tc 99m Sulfur Colloid; Transducers, Pressure; Urethra; Urinary Bladder; Urodynamics; 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

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

This retrospective study documents the findings on nuclear cystography and renal sonography of 455 girls who had urologic imaging for a proved urinary tract infection (UTI). Nuclear cystograms were normal in 313 (69%) of 455 patients. Vesicoureteral reflux was seen in 142 patients (31%): six with grade I, 90 with grade II, 43 with grade III, and three with grade IV. Twelve percent of patients with vesicoureteral reflux had renal parenchymal scars. Increasing grades of reflux were associated with an increase in the severity and number of parenchymal scars. Normal renal sonograms were seen in 83% of patients. Abnormalities noted on sonograms included parenchymal scarring in 31 (7%) of the 455 patients, anomalies in 19 patients (4%), mild to moderate dilatation of the renal pelvis and or ureters in 45 patients (10%), and bladder wall thickening in 45 patients (10%).

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Female; Humans; Infant; Kidney; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Sulfur Colloid; Ultrasonography; Ureterocele; Urinary Bladder; Urinary Tract Infections; Vesico-Ureteral Reflux

Topics: Child; Child, Preschool; Female; Humans; Male; Pentetic Acid; Radionuclide Imaging; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid; Ultrasonography; Urinary Bladder; Urination; Urography; Vesico-Ureteral Reflux

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney Diseases; Male; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Urinary Bladder; Urination; Vesico-Ureteral Reflux

Thirty children were studied using both direct (catheter) and indirect techniques of radionuclide cystography. Of 54 ureters able to be compared, six showed vesico-ureteric reflux (VUR) on the direct study but were read as negative on the indirect cystogram, and five showed no reflux on the direct cystogram but were read as positive for VUR on the indirect study. (Sensitivity of 68% and specificity of 86%). Regarding ureters read as true positives on indirect study, if that ureter has ever shown reflux at any time, or if it drained a scarred kidney specificity was improved to 97% without changing the sensitivity. Concerns about the validity of indirect cystogram results and the ease of assessment and low radiation dose from the direct cystogram has made direct cystography our preferred technique.

Topics: Child; Child, Preschool; Female; Humans; Infant; Male; Methods; Pentetic Acid; Radiation Dosage; Radionuclide Imaging; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid; Ureter; Urinary Bladder; Urinary Catheterization; Vesico-Ureteral Reflux