Cyclic Direct Radionuclide Cystography in the Diagnosis and Characterization of Vesicoureteral Reflux in Children and Adults

Purpose To investigate the influence of cyclic direct radionuclide cystography (RNC) on the diagnosis of vesicoureteral reflux (VUR) in children and adults. Patients and Methods A total of 362 examinations were performed in patients with a mean age of 15.8 +/- 17.2 years (2 months to 76.4 years, 89.5% female). The examinations were divided into 3 groups of age: A, younger than 5 years; B, 5 years and younger than 14 years; and C, older than 14 years. Repeated cycles of bladder filling without removal of the catheter were performed. Results VUR was diagnosed in 21% of patients based on the first cycle, 5.5% in the second cycle, and 2.5% only in the third cycle. Most examinations showing VUR corresponded to grade II. Reflux occurred in only the filling phase in 10%, only the voiding phase in 27%, and both phases in 63% of patients. There was a higher incidence of reflux in groups A and B than group C after the first cycle. The second cycle was equally effective in diagnosing VUR in all 3 groups. In group A, the third cycle was more effective compared to the other groups. Conclusions Performing a second and a third cycle in RNC yielded an additional VUR diagnosis of 35.7%, as compared to performing only 1 cycle. The second cycle showed efficacy in all the groups, whereas the third cycle diagnosed more VUR only in group A. These results confirmed the importance of performing additional cycles in RNC for VUR diagnosis, both in children and adults.