COMPARISON OF DIRECT RADIONUCLIDE CYSTOGRAPHY WITH MICTURATING CYSTOURETHROGRAPHY FOR THE DIAGNOSIS OF VESICOURETERAL REFLUX, AND ITS CORRELATION WITH CYSTOSCOPIC APPEARANCES OF THE URETERAL ORIFICES

Forty-eight patients with strong clinical suspicion of vesicoureteric reflux (VUR) as the cause for their renal disease; were subjected to d irect radionuclide cystography and roentgenographic micturating cystou rethrography for its detection. Forty-four of them underwent cystoscop y under local anaesthesia to document the position and appearance of t he ureteric orifices. Of the 92 kidney-ureter 'units' available for st udy, 20 had reflux positive on micturating cystourethrography and 22 h ad direct radionuclide cystography positivity. Two of the three units picked up on direct radionuclide cystography but missed on micturating cystourethrography were severe refluxes up to the renal pelvis. On th e other hand, one unit missed on direct radionuclide cystography but p icked up on micturating cystourethrography was a lower ureteric reflux . The sensitivity and specificity of direct radionuclide cystography t o detect VUR as compared to micturating cystourethrography is 95% and 95.8% respectively. The localization and appearance of ureteric orific es which were classified as per Lyon's classification greatly enhanced the predictive value of determining past or present VUR. Patients wit h golf-hole orifices placed laterally had 100% incidence of reflux. Th us, combining direct radionuclide cystography with cystoscopy may enha nce the predictive value for diagnosis of VUR even higher than a mictu rating cystourethrography study.