99mTechnetium-mercaptoacetyltriglycine scintigraphy with full bladder in patients with severe bladder dysfunction.
OBJECTIVE
We evaluated 99mtechnetium-mercaptoacetyltriglycine scintigraphy for detecting threshold bladder volume at which upper tract obstruction occurs in patients with bladder dysfunction.


METHODS
A total of 24 patients 19 to 74 years old with severe bladder dysfunction who underwent 99mtechnetium-mercaptoacetyltriglycine scintigraphy and videocystometrogram in a 4-year period were selected for retrospective study. 99mTechnetium-mercaptoacetyltriglycine scintigraphy was done with a full bladder with a mean instilled volume of more than 850 ml saline. In patients in whom an obstructed renal outflow pattern was observed saline was drained at a rate of 100 ml every 5 minutes while dynamic imaging was performed. If results were abnormal, the study was repeated with an empty bladder. Differential function, parenchymal transit time index and outflow efficiency were calculated.


RESULTS
Of the 24 patients 15 had an obstructed outflow pattern with a full bladder, which was relieved at a bladder volume of less than 390 ml (median 300, range 250 to 600). Only 2 of these 15 patients had a normal vesical end filling pressure of less than 20 cm H2O. There was no obstruction in 9 patients, of whom 5 had increased vesical end filling pressures. Followup in patients who had normal tracer outflow on a full bladder showed no decrease in renal function, while a small decrease was seen in patients who had obstructed outflow on a full bladder.


CONCLUSIONS
This novel, full bladder 99mtechnetium-mercaptoacetyltriglycine scintigraphic technique provides the ability to detect bladder volumes at which obstructive outflow patterns develop in patients with severe bladder dysfunction.
Nagabhushan
N
N
Institute of Nuclear Medicine, Middlesex Hospital, University College London Hospitals Trusts, London, United Kingdom.
Syed
R
R
Hoh
I M
IM
Syed
I
I
Ell
P J
PJ
Shah
P J R
PJ
Neild
G H
GH
Woodhouse
C R J
CR
Bomanji
J B
JB
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011866:Radioisotope Renography; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017263:Technetium Tc 99m Mertiatide; D001743:Urinary Bladder / Q000473:pathology*; D001748:Urinary Bladder Neck Obstruction / Q000150:complications* / Q000000981:diagnostic imaging*; D014556:Urine
D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide