CLINICAL STUDIES ON VESICOURETERAL REFLUK

Significance of Detection of “Missing VUR”

Abstract

We are sometimes embarrassed not to be able to observe vesicoureteral reflux (VUR) in the group of patients who have recurrent urinary tract infection with obvious pyelonephritic changes in their urograms. For the purpose of detecting this type of VUR, or “missing VUR”, voiding cystourethrography (VCU) was performed after subcutaneous injection of bethanechol chloride.
By this method, we could detect “missing VUR” in 8 ureters of 7 patients. In 5 patients VUR was frankly missing because there was no reflux on either side on the ordinary VCU before bethanechol injection, and in 2 patients reflux was missingly lateralized. These were managed as follows: anticholinergic and antibacterial agents to 4 patients with uninhibited bladder, and ureteroneocystostomy to 3 patients with normal bladder function. Clinical outcome has been quite satisfactory in all.
Missing VUR was not only final answer to some of the puzzling cases of urinary infection, but also offered a useful guide to a falsely unilateral VUR for aggressive bilateral ureteroneocystostomy. Thus we have not experienced patients who suffer from postoperative contralateral VUR since 1982.
Furthermore, radionuclide cystourethrography with bethanechol chloride is also valuable to minimize the exposure to the radioactive rays.