Positional installation of contrast cystography: A new approach in the diagnosis of vesicoureteral reflux

Abstract

INTRODUCTION Positional installation of contrast cystography (PIC cystography) represents a new method to identify vesicoureteral reflux (VUR) that is unrevealed by standard diagnostic procedures. It is performed by radiological examination of the vesicoureteral junction during cystoscopic installation of the contrast medium at the ureteral orifice. OBJECTIVE We studied the significance of PIC cystography to demonstrate VUR that failed to be revealed by standard voiding cystourethrography (MCUG), as well as the degree of the correlation of such a finding with endoscopic appearance and the position of the ureteral orifice (UO). METHOD The aim of the paper was to analyze a sample of 5 children (4 girls and 1 boy), aged 6-15 years (mean 9.8 years) with recurrent febrile urotract infections, complicated with scarring changes of the renal parenchyma and normal findings on MCUG. The grade of VUR demonstrated by PIC cystography was classified using the standard hydrodistensional scale. RESULTS All 5 patients had VUR, disclosed by PIC cystography, of whom in 4 it was unilateral and in one bilateral. Of 5 patients, 4 had VUR grade I and one grade II. All the children with VUR detected by PIC cystography also had evident cystoscopic abnormalities in the position and/or configuration of the ureteral orifice at the same side, while at the side with normal finding on PIC cystography, the endoscopic finding was also within normal limits. CONCLUSION PIC cystography is the method of choice in the confirmation of VUR as the cause of recurrent urotract infection and its complications in children with a normal finding on standard MCUG. In all our patients with VUR verified by PIC cystography, at the same side we also revealed endoscopic changes in the position and/or configuration of UO.