Clinical experience with positional installation of contrast cystography and simultaneous Deflux injection in children with occult vesicoureteral reflux.

Forty-seven otherwise healthy children with a diagnosis of urinary tract infection and pyelonephritis were referred for evaluation following standard imaging studies which showed no renal abnormalities and a normal voiding cystourethrogram. All were evaluated with positional instillation of contrast at the time of cystoscopy using spot fluoroscopy to detect vesicoureteral reflux. Simultaneous Deflux injection was performed if reflux was demonstrated at cystoscopy. Seventy-five per cent had reflux demonstrated and were treated. The study group was followed for an average of 16 months and the incidence of pre- and post-treatment febrile infections were compared. A significant reduction in febrile infections was noted following treatment. Three children continued to have febrile urinary infections and were successfully reimplanted and experienced no further febrile urinary infections. No complications from this study occurred and some factors were discovered which may help in deciding which patients may benefit from this approach. These findings may provide new insights on the entity of non-refluxing pyelonephritis.