Cystoscopic and DMSA findings in relation to types of reflux demonstrated on percutaneous direct radionuclide cystography in children

Background The new technique of percutaneous direct radionuclide cystography (PDRC) allows the accurate demonstration of vesicorenal reflux under physiological conditions during resting and micturition phases. Five types of reflux have been described, the clinical relevance of which is uncertain.Objective To determine whether a relationship exists between the type of reflux identified on PDRC and the appearance of the ureteric orifice at cystoscopy or the prevalence of renal abnormalities.Materials and methods The reports of 281 PDRC examinations were reviewed and 76 children with reflux formed the population of this study. Studies of these children were reviewed to classify the reflux as types 1–5, and patient records were searched for cystoscopy and DMSA scan reports.Results Regardless of the type of reflux, the ureteric orifices were found to be open at cystoscopy in 60–66% of refluxing units. DMSA scan abnormalities were present in 68% of units with reflux at rest, 61% of units with reflux on micturition and 86% of units with reflux on both resting and micturition phases. In comparison with contralateral units that did not reflux, the presence of reflux had a significant association with openness of the ureteric orifice (p<0.00001) and DMSA abnormality (p<0.005).Conclusions Reflux of any type is strongly associated with an open ureteric orifice. Units that reflux during both resting and micturition phases had a higher incidence of DMSA abnormality than those refluxing during one phase only, but this was not statistically significant.