The detection and characterization of vesicoureteral reflux in the child.

Voiding cystourethrography or radionuclide cystography should be performed in the child in whom it is important to know whether reflux is present. Voiding cystourethrography is more accurate in characterizing and grading reflux, and monitoring is intermittent. Conversely, radionuclide cystography uses a lower radiation dose and its continuous monitoring leads to fewer false negative results but its ability to characterize reflux is poor. The performance of voiding cystourethrography or radionuclide cystography to detect reflux is an art as well as a science. These tests are done best by those who are experienced and interested in imaging the urinary tract of the child. At our hospital we perform voiding cystourethrography in all young children with urinary tract infection to detect and precisely characterize reflux to enable intelligent planning of management. In older patients, when it is less likely that reflux is present but it is still desirable to ensure that reflux is not occurring, radionuclide cystography is performed. If reflux is present, then a decision is made on an individual basis as to whether additional characterization by voiding cystourethrography is needed. Radionuclide cystography is also used for family screening, for periodic followup of reflux being managed nonoperatively and to ensure that reflux has been eliminated after antireflux surgery.