Quantitative nuclear cystography does not predict outcome in patients withprimary vesicoureteral reflux

Purpose: Quantitative nuclear cystography has been advocated as a tool for determining the prognosis in children with primary vesicoureteral reflux. W e reviewed our data on this technique to assess its usefulness for predicti ng the outcome in this population. Materials and Methods: We retrospectively reviewed the records of all patie nts with primary reflux in whom findings were positive on at least 2 nuclea r cystograms at our institution between 1992 and 1997. Patients followed at least 3 years were stratified according to outcome. Unfavorable prognostic criteria included bladder volume at reflux onset 60% or less of total blad der capacity and calculated volume of reflux 2% or greater of bladder capac ity. Results: Of the 107 patients in our study 63 were followed for 3 years or l onger, and reflux resolved in 17, was repaired in 24 and persisted in 22. M ean patient age at latest followup, duration of followup and number of cyst ograms did not significantly differ among groups. Intermittent reflux in 33 % of the patients followed 3 years or longer was not associated with outcom e or detrusor instability. Bladder and reflux volume varied and was nonpred ictive in individuals. Conclusions: Quantitative nuclear cystography did not predict the outcome i n patients followed for primary vesicoureteral reflux at a single instituti on for 3 years or longer. Intermittent reflux was common. These data sugges t that nuclear cystography cannot be used to assess reliably the prognosis in individuals. Strong consideration should be given to using negative find ings on 2 cystograms to confirm reflux resolution in patients at high risk.