Q: What is the diagnosis?
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A: Vesicoureteric reflux (VUR)
Q: What grade reflux is this? Why?
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A: Grade 5: tortuous ureter with severe dilatation of ureter and pelvicalyceal system and loss of fornicies and papillary impressions.
Q: What are the congenital anomalies associated with VUR?
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A: Posterior urethral valve and duplex kidney
Q: A similar case shows reflux of dye into the renal pelvis, however no dilatation of collecting system is seen. What should be the grade of VUR and what would be the treatment modality?
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A: Grade 2 vesicoureteric reflux, and it can be treated with antibiotic prophylaxis.
Q: What should be the recommended treatment for our case?
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A: Bilateral ureteric reimplantation is suggested in bilateral grade V vesicoureteric reflux.
Q: A female child has undergone three VCUG examinations in last six months, for grading VUR. Pediatrician wants another examination with lesser radiation dose. Do we have any choice?
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A: Radionuclide cystography has lesser radiation dose than VCUG, and has very high sensitivity. It is not useful for morphologic assessment of the ureters, however. MRI-VCUG and echocontrast cystosonography has also been used with good results but is as yet not widely available.
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