A prospective study comparing direct radionuclide cystography with voiding cystourethrography in the detection and grading of vesicoureteric reflux in childrenAuthor(s):
Dr. MD Khizer Razak and Dr. Sudhakar RAbstract: Background:
Vesico ureteric reflux (VUR) is an important preventable cause of renal failure in pediatric urology. It may be present antenatally and an early detection is crucial to contain the progressive renal damage it can inflict in the early years of life. Voiding Cystourethrography (VCUG), and more recently Direct Radionuclide Cystography (DRCG) are standard tests used to detect and grade VUR. These tests have distinct advantages and disadvantages.
Aims & Objectives: The aims of this study were 1. To compare the efficacy of DRCG in detecting VUR as compared to VCUG (VCUG being taken as the reference standard). 2. To propose a viable grading of VUR on the DRCG.
Methods:A prospective, cross-sectional study that enrolled 54 children was performed. Inclusion criteria were: 1. Children less than 12 years being evaluated for VUR, 2. a sterile urine culture at the time of the tests and 3. Both tests performed within 24 hours of each other (same day study). Demographic data, presenting complaint, provisional diagnosis and presence & grade of reflux on both the tests were documented. Specific statistical parameters in detecting and grading VUR with a DRCG were calculated.
Results: DRCG detected 22 of the 32 renal units that had VUR on the VCUG. It had a sensitivity of 69%, specificity of 100%, positive predictive value of 100%, negative predictive value of 88%, accuracy 91% and Coefficient of Agreement -Kappa of 0.76 (highly significant) in detecting VUR as compared to VCUG. Low grade (IRSC I, II) VUR was likely to be on missed on DRCG. Whenever DRCG demonstrated a VUR, the VCUG also showed it. Despite minor differences, we note considerable agreement between the two systems (accuracy - 77.78%, coefficient of agreement with VCUG - Kappa of 0.48, significant) in the grading of VUR.
Conclusions: DRCG compared modestly with VCUG in detecting VUR. A voiding study is suggested to improve the sensitivity. A practical three tier grading of VUR on DRCG with a superior statistical correlation (accuracy -90.76%, coefficient of agreement with VCUG - Kappa of 0.773, highly significant) with the IRSC grading on the VCUG is proposed: A – radioactivity in the ureter (corresponding to IRSC grade I), B – radioactivity in the undilated /minimally dilated pelvicalyceal system, (corresponding to IRSC grades II / III), C – radioactivity in the dilated pelvicalyceal system (corresponding to IRSC grades IV / V). Of these, A and B are Low Grade while C is High Grade VUR.Pages: 30-38 | Views: 784 | Downloads: 471Download Full Article: Click Here
How to cite this article:
Dr. MD Khizer Razak, Dr. Sudhakar R. A prospective study comparing direct radionuclide cystography with voiding cystourethrography in the detection and grading of vesicoureteric reflux in children. Int J Multidiscip Trends 2019;1(1):30-38.