[Role of direct radionuclide cystography and renal study by dimercaptosuccinic acid (DMSA) in the diagnosis and follow-up of vesicoureteral reflux].
OBJECTIVE
To evaluate the role of isotopic studies in the diagnosis and follow-up of vesicoureteral reflux (VUR) and to present the results of our current protocol.


METHODS
Forty three patients with VUR were retrospectively studied with a mean follow-up of 43 years (1-11 years). VUR was diagnosed by voiding cystourethrography and followed-up by direct radionuclide cystography. During the follow-up all patients were studied by means of renal DMSA scintigraphy (21 were also studied during the acute phase of febrile urinary tract infection).


RESULTS
Eighty three renal units were examined. Voiding cystourethrography was positive for VUR in 49 renal units (59%; 8 grade I, 18 grade II, 15 grade III, and 8 grade IV). During the follow-up, direct radionuclide cystography showed decrease or disappearance of VUR in 29 renal units (35%; 4 grade I, 16 grade II, 7 grade III, and 2 grade IV). DMSA studies performed during the follow-up showed cortical lesions in 17 renal units (5 with VUR grade II, 7 with grade III, and 5 grade IV). Nine of 21 patients examined by DMSA during the acute phase of febrile urinary tract infection showed cortical damage (43%), and 6 of them (67%) progressed to cortical lesion in the follow-up DMSA.


CONCLUSIONS
The present protocol allows for the correct diagnosis and control of VUR, the early detection of acute renal damage, and the control of its evolution.
Servicio de Medicina Nuclear, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
V
V
Camacho Martí
M
M
Estorch Cabrera
J
J
Caffaratti Sfulcini
G M
GM
Fraga Rodríguez
A
A
Orsola De Los Santos
L
L
Rodríguez Villamil
J M
JM
Garat Barredo
J
J
Cubells Rieró
I
I
Carrió Gasset
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007672:Kidney Cortex / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D011859:Radiography; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D019783:Technetium Tc 99m Dimercaptosuccinic Acid / Q000627:therapeutic use*; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
D019783:Technetium Tc 99m Dimercaptosuccinic Acid