Comparison of Two Diagnostic Methods of Vesicoureteral Reflux in Children with Urinary Tract Infection

Urinary tract infection is common in children and vesicoureteral reflux is one of its predisposing factors. Contrast cystography and radionuclide cystography are two common methods for the diagnosis of vesicoureteral reflux. This study compared two methods, indirect radionuclide cystography (IRC) with voiding cycling method and voiding cystoureterography with contrast (VCUG). This analytical study was conducted on 55 children with urinary tract infection who were referred to our nephrology clinic in six months. In order to diagnose urinary reflux, 109 ureters (one child had a single kidney) were evaluated using IRC and VCUG methods with a one-month interval. Kappa coefficient was used to determine the agreement rate, and the McNemar’s test was employed to compare the ability of two methods in the diagnosis of VUR. The mean age of the children was 5.4 years (range: 6 months to 13 years). A total of 38 children (69%) were female and 17 (30.9%) were male. Seventy percent of the children older than three years old had urinary control. From 109 ureters, 29 (26.4%) with urinary reflux were detected by the IRC method, whereas only 15 (13.6%) were diagnosed using VCUG. Statistically, the two methods did not have agreement in the diagnosis of VUR (Kappa: 0.556, p< 0.001) and the IRC method had more power to diagnose VUR in comparison with VCUG. Although we observed a significant difference in the diagnostic value of two methods, the choice of diagnostic method depends on specific technical conditions. However, in ideal conditions, the IRC method is suggested to be performed since it is more powerful in the diagnosis of urinary reflux.