Valor de la cistogammagrafía directa en el diagnóstico del reflujo vesicoureteral en pacientes con hidronefrosis prenatal / Value of the direct cystoscintigraphy in the diagnosis of vesicoureteral reflux in patients with prenatal hydronephrosis

Objetivo. Dado que la radiación recibida en una cistografía convencional, es del orden de 20 veces superior a la de una cistografía isotópica y que la sensibilidad de ésta última, es más alta en el diagnóstico del reflujo vésicoureteral, nos planteamos su utilización en el despistaje de este, en pacientes con hidronefrosis congénita. Material y métodos. En el periodo 2003-2009, se ha aplicado el siguiente protocolo a los neonatos con antecedentes de hidronefrosis prenatal con la finalidad de descartar reflujo. Profilaxis antibiótica si se confirma en ecografía a la semana de vida la dilatación de la vía excretora, a las 6 semanas de vida, se realiza nuevo control ecográfico, en el cual si la ectasia es superior a 8 mm, se practica cistogammagrafía directa. Si se trata de un niño de sexo masculino con dilatación o afectación parenquimatosa severa, o en casos en que se sospeche duplicidad, se practica cistografía convencional. Resultados. De los 65 casos estudiados, se ha detectado reflujo en 13 pacientes (20%) en 18 unidades renales (3 leve, 8 moderado y7 severo). El seguimiento se ha realizado en la mayoría de casos concistografía isotópica. Ninguno de los 13 pacientes con refl ujo a los que (..) (AU)

Objective. As the radiation received in conventional cystographyis about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral refl ux, we consider the use of radionuclide cystography in early detection of refluxin patients with prenatally detected hydronephrosis. Materials and methods. Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide escintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed (..) (AU)

[Value of the direct cystoscintigraphy in the diagnosis of vesicoureteral reflux in patients with prenatal hydronephrosis]. / Valor de la cistogammagrafía directa en el diagnóstico del reflujo vesicoureteral en pacientes con hidronefrosis prenatal.

OBJECTIVE: As the radiation received in conventional cystography is about 20 times higher than radionuclide cystography and the sensitivity of the last is higher in order to diagnose vesicoureteral reflux, we consider the use of radionuclide cystography in early detection of reflux in patients with prenatally detected hydronephrosis. MATERIALS AND METHODS: Between 2003 and 2009, a study of neonates with prenatal history of hydronephrosis was performed in order to rule out reflux. Our protocol was as follows: The diagnosis was confirmed by postnatal ultrasound at 1 week (in this case patient initiate antibiotic prophylaxis). A new ultrasound was repeated at 6 weeks, if the dilatation was larger than 8 mm at this time, direct radionuclide scintigraphy was performed. The patients were placed on prophylactic antibiotics until the screenining results were known. Conventional cystography was performed if a male infant showed severe dilatation, or in general in cases with parenchymatous atrophy or if a duplex system was suspected. RESULTS: In 13 (20%) of the 65 cases (18 kidneys) reflux was detected (3 minor, 8 moderate and 7 severe). In most cases, follow up was performed with radionuclide cystography. None of the patients with reflux placed on prophylactic antibiotics developed a febrile urinary tract infection during the first year of life. CONCLUSIONS: Direct radionuclide cystography is a useful diagnostic method in early detection of vesicoureteral reflux in patients with prenatal hydronephrosis with higher sensitivity than conventional cystography, and with an important advantage concerning radiation of the patient. Patients screened and placed on prophylactic antibiotics are probably going to present less episodes of pielonephrytis.