title: Positioning irrigation of contrast cystography for diagnosis of occult vesicoureteric reflux: association with technetium-99m dimercaptosuccinic acid scans.
abstract: OBJECTIVE
  Positioning irrigation of contrast (PIC) cystography identifies occult or PIC vesicoureteral reflux (PIC-VUR) in children with recurrent febrile urinary tract infections (UTI) but no vesicoureteric reflux (VUR) on standard voiding cystourethrogram (VCUG). We sought to identify the relationship between PIC-VUR and renal scarring in technetium-99m dimercaptosuccinic acid (DMSA) scans.
  
  
  METHODS
  We retrospectively analysed PIC cystograms and DMSA scans for 154 kidneys in 81 children (65 girls; 16 boys; median age, 4.7 years; range, 0.9-15.2). Renal scarring was graded on a scale of 0-3. DMSA scans were pathologic in 66 patients (81%). Children had experienced mean 3.8 febrile UTI (range 1-25). Forty-seven (58%) children had a history of reflux, including 15 (19%) with previous anti-reflux operations. Indications for PIC cystography were recurrence of febrile UTI after either bilateral negative VCUG (66 children) or unilateral VUR (15 children) with contralateral/bilateral scarring or reflux that had changed sides in subsequent VCUGs.
  
  
  RESULTS
  PIC-VUR was bilateral in 63, unilateral in 12, and absent in 6 children. Statistically significant associations between PIC-VUR grade and severity of renal scarring were identified in inter-individual (n = 77, p = 0.017) and intra-individual (refluxing vs. nonrefluxing kidney; n = 12, p = 0.008) analyses. After excluding patients with history of VUR, statistical significance was maintained in inter-individual analysis (n = 49; p = 0.018).
  
  
  CONCLUSIONS
  The data suggest an association between PIC-VUR and severity of renal scarring, and legitimise the use of PIC cystography in children with renal scarring due to recurrent febrile UTI but negative findings on VCUG.
authors.affiliation: Department of Pediatric Urology, Krankenhaus der Barmherzigen Schwestern, Seilerstätte 4, 4020 Linz, Austria. Electronic address: christoph.berger@bhs.at.
authors.forename: Christoph
authors.initials: C
authors.lastname: Berger
authors.forename: Tanja
authors.initials: T
authors.lastname: Becker
authors.forename: Mark
authors.initials: M
authors.lastname: Koen
authors.forename: Mazen
authors.initials: M
authors.lastname: Zeino
authors.forename: Friedrich
authors.initials: F
authors.lastname: Fitz
authors.forename: Mohsen
authors.initials: M
authors.lastname: Beheshti
authors.forename: Iris
authors.initials: I
authors.lastname: Wolf-Kohlmeier
authors.forename: Silke
authors.initials: S
authors.lastname: Haim
authors.forename: Marcus
authors.initials: M
authors.lastname: Riccabona
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D007507:Therapeutic Irrigation; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging; D014567:Urography / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid