ALTERNATIVE APPROACHES TO THE PROGNOSTIC STRATIFICATION OF MILD-TO-MODERATE PRIMARY VESICOURETERAL REFLUX IN CHILDREN

Purpose: We compared the prognostic stratification of primary vesicour eteral reflux by performing staging voiding cystourethrography in all children with a urinary tract infection or only in those with renal sc arring on (99m)technetium-dimercapto-succinic acid (DMSA) scintigraphy . Materials and Methods: Staging voiding cystourethrography and DMSA s cintigraphy were performed in 105 children with a urinary tract infect ion and reflux persistence was assessed by radionuclide cystography af ter a 2-year followup. Results: Staging voiding cystourethrography rev ealed no reflux in 51 children (DMSA positive in 3), grades I to II re flux in 21 (DMSA positive in 6) and grade III reflux in 33 (DMSA posit ive in 19). On followup radionuclide cystography no new reflux was det ected, and it was no longer demonstrated in 23 children (8 with grade III and 15 with grades I to II reflux). The finding of grade III reflu x on staging voiding cystourethrography had a 76% positive and a 92% n egative value for predicting persistent reflux with an 87% predictive accuracy. Limiting the evaluation of voiding cystourethrography data t o the 28 children with a positive DMSA scan the combination of renal s eaming and grade III reflux had an 84% positive and an 83% negative pr edictive value with 83% accuracy. This approach would have prevented 7 7 children from having to undergo voiding cystourethrography. Conclusi ons: Performance of staging voiding cystourethrography exclusively in children with renal scarring on a DMSA scan resulted in predictive acc uracy that was close to what was achieved by performing voiding cystou rethrography in all children with a urinary tract infection. To be abl e to limit cystourethrography to a select population could prove to be cost-effective.