Does the conventional cystogram exaggerate reflux?

We studied 35 patients with anterograde and retrograde cystography. Many patients who had reflux on retrograde cystography either did not have reflux or the reflux was reduced significantly on anterograde cystography. Furthermore, when reflux was seen on anterograde cystography it appeared to have more prognostic value than when seen on retrograde cystography. The question is raised of whether much reflex seen on retrograde cystography is not actually an artifact of the examination and does not exist beyond circumstances of the test.