title: [Value of the direct cystoscintigraphy in the diagnosis of vesicoureteral reflux in patients with prenatal hydronephrosis].
abstract: OBJECTIVE
  As the radiation received in conventional cystography is about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral reflux, we consider the use of radionuclide cystography in early detection of reflux in patients with prenatally detected hydronephrosis.
  
  
  METHODS
  Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide scintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed severe dilatation, or in general in cases with parenchymatous atrophy or if a duplex system was suspected.
  
  
  RESULTS
  In 13 (20%) of the 65 cases (18 kidneys) reflux was detected (3 minor, 8 moderate and 7 severe). In most cases, follow up was performed with radionuclide cystography. None of the patients with reflux placed on prophylactic antibiotics developed a febrile urinary tract infection during the first year of life.
  
  
  CONCLUSIONS
  Direct radionuclide cystography is a useful diagnostic method in early detection of vesicoureteral reflux in patients with prenatal hydronephrosis with higher sensitivity than conventional cystography, and with an important advantage concerning radiation of the patient. Patients screened and placed on prophylactic antibiotics are probably going to present less episodes of pielonephrytis.
authors.affiliation: Servicios de Cirugía Pediátrica, Hospital Universitari Mútua Terrassa, Barcelona. 25441jmm@comb.cat
authors.forename: J
authors.initials: J
authors.lastname: Margarit Mallol
authors.forename: S
authors.initials: S
authors.lastname: Vallejo Aparicio
authors.forename: A
authors.initials: A
authors.lastname: García Henares
authors.forename: C
authors.initials: C
authors.lastname: Grande Moreillo
authors.forename: P
authors.initials: P
authors.lastname: Glasmeyer
authors.forename: N
authors.initials: N
authors.lastname: Magro Benito
authors.forename: M
authors.initials: M
authors.lastname: Buxeda Figuerola
mesh_terms: D005260:Female; D005315:Fetal Diseases; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000209:etiology