(Marmara Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
David Terence THOMAS
(Maltepe Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
Raziye ERGÜN
(Marmara Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
(Marmara Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
Harika ALPAY
(Marmara Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
Sabahat İNANIR
(Marmara Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
E. Tolga DAGLI
(Marmara Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
(Marmara Üniversitesi, Tıp Fakültesi, İstanbul, Türkiye)
Yıl: 2018Cilt: 60Sayı: 2ISSN: 0041-4301Sayfa Aralığı: 180 - 187İngilizce

37 0
Positional installation of contrast (PIC) and Redo-PIC cystography for diagnosis of occult vesicoureteral reflux
To evaluate the value of Positional Installation of Contrast (PIC) and RedoPIC cystography in patients with febrile recurrent urinary tract infection (f-UTI) where voiding cystourethrogram (VCUG) was negative. Patients with recurrent f-UTI with no reflux on VCUG referred to the outpatient clinic of Pediatric Urology, between June 2011 and June 2016 were included in the study. A PIC cystography was performed in all patients. When reflux was found, subureteric injection was performed. Urinary cultures were used for follow-up. Patients that continued having f-UTI, received redo-PIC cystography. PIC cystography was performed on 42 patients. The average age of patients was 8.0±3.6 years. Vesicoureteral reflux (VUR) was detected in 41 patients. Average follow-up time after PIC cystography was 44.6 months. Thirty-three patients (80.5%) were free of f-UTI after PIC cystography and concurrent subureteric injection. Eight patients continued to have recurrent f-UTI. Six of these patients underwent redo-PIC cystography and PIC-VUR was demonstrated in all patients. After an average follow up of 30.9 months, no f-UTI was seen in these patients. The success rate of 80.5% (33/41) after 1st PIC cystography and subureteric injection increased to 95.1% (39/41) after redo-PIC cystography in six patients. Patients with recurrent f-UTIs without VUR on VCUG are an important challenge. PIC cystography is an important tool in demonstrating occult VUR in these patients. We advise that PIC cystography is performed in all patients with recurrent f-UTI with negative VCUG and redo-PIC cystography in patients who continue to have f-UTI after 1st PIC cystography and subureteric injection.
DergiAraştırma MakalesiErişime Açık
  • 1. Rushton HG. The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol 1997; 11: 108-120.
  • 2. Mir S, Ertan P, Ozkayin N. Risk factors for renal scarring in children with primary vesicoureteral reflux disease. Saudi J Kidney Dis Transpl 2013; 24: 54-59.
  • 3. Edmondson JD, Maizels M, Alpert SA, et al. Multiinstitutional experience with PIC cystography--incidence of occult vesicoureteral reflux in children with febrile urinary tract infections. Urology 2006; 67: 608-611.
  • 4. Elmore JM, Kirsch AJ, Lyles RH, Perez-Brayfield MR, Scherz HC. New contralateral vesicoureteral reflux following dextranomer/hyaluronic Acid implantation: incidence and identification of a high risk group. J Urol 2006; 175: 1097-1100; discussion 1100-1101.
  • 5. Tareen BU, Bui D, McMahon DR, Nasrallah PF. Role of positional instillation of contrast cystography in the algorithm for evaluating children with confirmed pyelonephritis. Urology 2006; 67: 1055-1057; discussion 1058-1059.
  • 6. Pinto KJ, Pugach J, Saalfield J. Lack of usefulness of positioned instillation of contrast cystogram after injection of dextranomer/hyaluronic acid. J Urol 2006; 176: 2654-2656.
  • 7. Noe HN, Williams MA. Clinical experience with positional installation of contrast cystography and simultaneous Deflux injection in children with occult vesicoureteral reflux. J Pediatr Urol 2007; 3: 375-377.
  • 8. Paintsil E. Update on recent guidelines for the management of urinary tract infections in children: the shifting paradigm. Curr Opin Pediatr 2013; 25: 88-94.
  • 9. Rubenstein JN, Maizels M, Kim SC, Houston JT. The PIC cystogram: a novel approach to identify “occult” vesicoureteral reflux in children with febrile urinary tract infections. J Urol 2003; 169: 2339-2343.
  • 10. Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 2006; 176: 314- 324.
  • 11. National Collaborating Centre for Women’s and Children’s Health. Urinary tract infection in children: Diagnosis, treatment and long-term management. 2007; 54: 84-114.
  • 12. Mingin GC, Hinds A, Nguyen HT, Baskin LS. Children with a febrile urinary tract infection and a negative radiologic workup: factors predictive of recurrence. Urology 2004; 63: 562-565; discussion 565.
  • 13. Bratslavsky G, Feustel PJ, Aslan AR, Kogan BA. Recurrence risk in infants with urinary tract infections and a negative radiographic evaluation. J Urol 2004; 172: 1610-1613; discussion 1613.
  • 14. Hagerty JA, Maizels M, Cheng EY. The PIC cystogram: its place in the treatment algorithm of recurrent febrile UTIs. Adv Urol 2008: 763620.
  • 15. Navai N, Halperin W, Maizels M, Yerkes EB, Hagerty J, Kaplan WE. Demonstraing Vesicoureteral Reflux by Positioning the Instillation of Contrast (PIC) Cystography is a Physiological Test by Manometry. J Urol 2008; 179: 203-203.
  • 16. Berger C, Becker T, Koen M, et al. Positioning irrigation of contrast cystography for diagnosis of occult vesicoureteric reflux: association with technetium-99m dimercaptosuccinic acid scans. J Pediatr Urol 2013; 9: 846-850.
  • 17. Pichler R, Heidegger I, Schlenck B, Horninger W, Oswald J. Clinical outcome after endoscopic therapy for occult vesicoureteral reflux in females: preliminary results of a retrospective case series. Scand J Urol 2014; 48: 387-392.
  • 18. Smellie JM, Barratt TM, Chantler C, et al. Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial. Lancet 2001; 357: 1329-1333.

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