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KMID : 1218220120040010017
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Korean Journal of Pediatric Urology
2012 Volume.4 No. 1 p.17 ~ p.21
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Postoperative 99mTc-DMSA Renal Cortical Scan in Primary Vesicoureteral Reflux in Infants
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Lee Yoon-Hyung
Kwon Joon-Beom
Kim Jae-Soo
Cho Sung-Ryong
Zeon Seok-Kil
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Abstract
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Purpose: The 99mtechnetium-dimercaptosuccinic acid renal cortical scan (DMSA scan) has been proved to be superior in sensitivity and specificity to detecting renal scars in children’s repeated urinary tract infection. But there is rare report in the investigation of the utility of DMSA scan for the evaluation of the anti-reflux surgery performed on infants. This study is to investigate the clinical utility of follow-up DMSA scan, in infants who had a history of urinary tract infection with vesicoureteral reflux (VUR) and underwent anti-reflux surgery.
Materials and Methods: This study was performed on 24 infants who were diagnosed with primary VUR and underwent open or endoscopic anti-reflux surgery between March 2008 and September 2010 at Keimyung University
Dongsan Hospital and Daegu Fatima Hospital in Daegu City, South Korea. Preoperative voiding vesicourethrography (VCUG) and DMSA scan were performed 4.4±2.6 months before the surgery. In all cases, the DMSA scan was performed within 5 days after the diagnosis of urinary tract infection. Six months after surgery, VCUG and DMSA scan was done. Out of the 24 cases, 9 were bilaterality and the other 15 were unilaterality. Submucosal injection was done on 19 patients (24 renal units) and open surgery on 5 (9 renal units). The grade of VUR followed the grading system established by International Reflux Study Committee (1985). The grading of renal scars is as follows: ‘grade 0’ as normal findings, a single, peripheral defect on DMSA scan as ‘grade I’, ‘grade II’ as more than two defects with well preserved renal outline, and ‘grade III’ as multiple defects with contracted kidney.
Results: The mean age of patients was 17.2 months (range 11-24). Male and female were 13 (18 renal units) and 11 (15 renal units), respectively. The follow-up was done 6.8±1.0 months after the anti-reflux surgery. Preoperative VUR grade on VCUG and renal scar grade on DMSA scan were 3.1±1.3 and 1.9±1.0 respectively. Six months after the surgery, they showed VUR grade 0.9±1.3 and renal scar grade 1.3±1.2. As a result, follow up DMSA scan shows significantly lowered grade of renal scar comparison with 6 months before (p＜0.05).
Conclusions: In spite of the limited duration of the follow up DMSA scan and relatively small size of the sample, follow up DMSA renal cortical scan is thought to be a useful method to evaluate the improvement of renal scars in acute urinary tract infection with VUR after surgical correction of the primary vesicoureteral reflux in infant before 2 years of age. Further more, study with larger sample size and long-term follow up examination of 12 months or more after anti-reflux surgery is recommended. And the study of DMSA scan comparison ultrasonography is recommended for further evaluation.
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KEYWORD
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Vesico-ureteral reflux, Radionuclide imaging
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