Figure 814

Voiding cystourethrogram demonstrating bilateral grade 5 vesicoureteral reflux. Voiding cystourethrography is performed by filling the bladder with radiocontrast material and observing for reflux under fluoroscopy, either during the phase of bladder filling or during micturition. Contrast material is infused through a small urethral catheter under gravity flow.

Radionuclide cystogram demonstrating bilateral vesicoureteral reflux (VUR). This method using 99mtechnetium pertechnetate is useful in detecting VUR. Advantages of radionuclide cystography include lower radiation exposure, less interference with overlying bowel contents and bones, and higher sensitivity in detection of VUR. Radionuclide cystography is useful in follow-up examinations of patients known to have VUR, as a screening test in asymptomatic siblings of children with reflux and girls with urinary tract infections, and in serial examinations of children with neuropathic bladders at risk for developing VUR. Disadvantages of this method include less anatomic detail and inadequacy in evaluating the male urethra, making it unsuitable for screening boys for urinary tract infections [7].

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