Percutaneous direct radionuclide cystography in children: description of technique and early experience.

AIMS: To describe a new test for vesicoureteric reflux in children and assess patient preference compared to indirect radionuclide cystography.

MATERIALS AND

METHODS

One hundred and three toilet-trained children aged between 2.1 and 15.6 years underwent percutaneous injection of 10-20 MBq of 99m-technetium-labelled mercapto-acetyl-triglycine (MAG3) into the full bladder after the application of anaesthetic cream. Gamma camera images of the bladder and renal areas were recorded during a 5-min resting period and during micturition.

RESULTS

All procedures were successful, 97 with a single stab. Fifty-four of the 66 children who expressed a preference preferred percutaneous suprapubic injection to intravenous injection. Images were easy to interpret and there were no indeterminate results. Of 200 renal units, 33 refluxed during the resting phase and 31 during micturition. In 24 renal units, reflux was only demonstrated during the resting phase. Reflux was significantly associated with abnormalities on dimercaptosuccinic acid (DMSA) scans ( P<0.001).

CONCLUSIONS

The new technique of direct percutaneous radionuclide cystography is described. It was well tolerated by patients. It detects reflux during the resting phase that would be missed on the indirect study and avoids doubt as to whether activity in the renal areas is due to reflux or excretion. Free pertechnetate could be used and would be much cheaper.