Cyclic voiding cystourethrography in the diagnosis of occult vesicoureteric reflux

Cyclic voiding cystourethrography (CVC) enhances the detection of vesicoure teric reflux (VUR). We investigated whether more-severe VUR may be overlook ed, and whether older children are at risk of having their VUR missed with the conventional single-cycle study. Three hundred and seventy patients, 16 8 boys and 202 girls aged 1 month to 16 years, consecutively admitted over 1 year for suspicion of VUR, underwent two complete cycles of filling and v oiding CVC. One-hundred and four subjects, 33 boys and 71 girls, were older than 3 years (mean age 5.7 years, range 3.2-16 years). Sixty-six refluxing ureters from 51 patients were identified in the first cycle and 61 refluxi ng ureters from 45 patients were identified only with the second circle. Fo ur instances of grade IV VUR in 4 patients and three of grade IV VUR in 3 p atients were overlooked completely in the first cycle. Seven episodes of VU R less than or equal to grade III from 5 patients diagnosed in the first cy cle were upgraded to greater than or equal to grade IV at the second cycle. The presence of VUR was identified only in the second cycle in 35 of 74 su bjects aged less than or equal to 3 years and in 10 of 22 aged >3 years (no t significant). Of the 10 children aged >3 years, 2, who had diagnosis only at the second cycle, had greater than or equal to grade IV VUR. More;sever e VUR may be overlooked or down-graded in a single-cycle study. Two-cycle C VC is also useful in children older than 3 years.