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Introduction
Clinical presentation
Clin. aproach to ivestig. and menag. of UTI
Cortical scintigraphy in urinary tract infection
Cystigraphy in urinary tract infection
Vesicourethral reflux (VUR)
The grading systems for vesicourethral eflux
Detection of vesicourethral reflux
Micturating cystourethrography (MCUG)
Radionucleotide cystography (RNC)
Direct radionuclide cystography (DRC)
Indirect radionuclide cystography (IRC)
Dynamic renal scintigraphy in UTI
Practical problems in pediatric nucl.med.
Preparation
Dose schedule
Injection
Imobilisation/ sedation
Conclusion

4. CYSTOGRAPHY IN URINARY TRACT INFECTION

4.1. VESICOURETERIC REFLUX (VUR)

Although a huge amount of literature is devoted to the significance, diagnosis, prognosis and treatment of vesicoureteral reflux, major controversies still exist. When to look for reflux? Which technique is the most appropriate for its detection? How important is reflux as a predictive factor for acute renal lesions or for permanent scarring? Which treatment should be applied? After so many years of experience with cystography, we still need better standardization ofmethodology[9]. Vesicoureteric reflux is caused by a failure of the ureterovesical valve , which may in turn be caused by a congenital variation, immaturity, or a pathological process. The incidence of VUR in general population is unknown. A study reports 1% incidence of VUR in group of 536 apparently normal neonates, infants, and children. VUR may be associated with pyelonephritis, which is in turn may lead to hypertension and chronic renal failure. Early identification of VUR and assessment of renal integrity are important in children suffering from UTI in order to prevent reflux nephropathy and ultimately, renal damage. However, many studies in recent years have documented that VUR is present in only minority of patients with pyelonephritis The article by Benador et aLemphasizes the changing nature of the diagnosis of UTI in children[7]. There are data that 30% of children with UTI have reflux. 30 % of children with pyelonephritis have reflux as well. 70% of refluxes will resolve spontaneously (grades 1,2,3, but grades 4 and 5 do not resolve). But, probably above 80% children with permanent renal scarring have reflux. The controversy still exists, and further investigations should be performed.

Patients diagnosed with VUR are usually followed by repeated cystographic studies every 6- 12 months to monitor the persistence or resolution of reflux. Prophylactic antibiotic therapy is administered until reflux resolves spontaneously. If reflux does not resolve spontaneously after period of time , which varies for each individual, surgery may be indicated[10].

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