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What is In a patient suspected to be suffering from vesicoureteric reflex, which one of the following radiological investigations may confirm the diagnosis ? and explain in detail?
VUR is confirmed by a micturating cystogram and a DMSA scan is used to assess the degree of renal scarring. VUR occurs in 1-2% of the asymptomatic paediatric population but in 30-40% of children with a UTI and is apparent in 90% of children with renal scarring on an IVU. VUR is graded as follows: Grade I: reflux into the ureter. Grade II: reflux into the ureter and renal pelvis. Grade III: reflux is associated with mild/moderate dilatation on an IVU. Grade IV: additional blunting of fornices. Grade V: absent papillary impressions. Grades I-III generally resolve spontaneously. Surgery (ureteric re-implantation, periureteric injections of Teflon or collagen) should be considered if episodes of acute PN recur despite antibiotic therapy or if severe reflux is accompanied by a surgically correctable malformation. (source : Bailey 27th ed , chapter 76 , pg no 1404