Tareen Basir U, Bui Don, McMahon Daniel R, Nasrallah Phillip F
Department of Urology, Northeastern Ohio University College of Medicine, Children's Hospital Medical Center of Akron, Akron, Ohio, USA.
Urology. 2006 May;67(5):1055-7; discussion 1058-9. doi: 10.1016/j.urology.2005.11.066.
To assess the utility of positional instillation of contrast (PIC) cystography in detecting vesicoureteral reflux (VUR) in patients with renal scarring from recurrent febrile urinary tract infections that standard voiding cystourethrography and nuclear cystogram imaging failed to reveal.
Between June 2004 and November 2004, a total of 5 pediatric patients with recurrent febrile urinary tract infections and radiologic evidence of upper tract involvement were examined with PIC cystography. All patients had at least one previous negative standard reflux study (voiding cystourethrography or nuclear cystography).
All 5 patients showed VUR on PIC cystography. Unilateral reflux was detected in 3 patients, and 2 patients had bilateral VUR.
The PIC cystogram should be integrated into the algorithm for diagnosing patients with recurrent febrile urinary tract infection, who do not exhibit VUR on standard imaging modalities. The morbidity associated with undiagnosed VUR, as demonstrated by this group of patients, suggests that permanent renal damage may be prevented by early diagnosis and treatment.
评估造影剂体位性灌注（PIC）膀胱造影术在检测复发性发热性尿路感染导致肾瘢痕形成患者的膀胱输尿管反流（VUR）方面的效用，而这些患者的标准排尿膀胱尿道造影和核素膀胱造影成像均未能显示出反流情况。
在2004年6月至2004年11月期间，共有5例复发性发热性尿路感染且有上尿路受累影像学证据的儿科患者接受了PIC膀胱造影检查。所有患者此前至少有一次标准反流检查（排尿膀胱尿道造影或核素膀胱造影）结果为阴性。
所有5例患者在PIC膀胱造影中均显示有VUR。3例患者检测到单侧反流，2例患者有双侧VUR。
对于在标准成像方式下未显示VUR的复发性发热性尿路感染患者，PIC膀胱造影应纳入诊断流程。正如这组患者所表明的，未诊断出的VUR相关发病率提示，早期诊断和治疗可能预防永久性肾损伤。
