Putting your child through a bunch of testing is never any fun. Unfortunately, it’s necessary to diagnose and properly treat Vesicoureteral Reflux. The most common test for diagnosing VUR is a Voiding Cystourethrogram (VCUG), but there may be other tests, including renal ultrasound, DMSA scan (or Mag3), Urodynamics (or video-urodynamics), or an MRI.
A VCUG can be a pretty scary and uncomfortable test for a child, but unfortunately it is necessary in diagnosing reflux. The initial VCUG is done without sedation in most cases, although there are some doctors that offer sedation. There is also another type VCUG, the nuclear VCUG, for follow-up testing. The nuclear VCUG is very sensitive in detecting reflux, but it cannot tell you what grade it is, only whether or not the reflux is still present which is why it is not used for initial diagnosis. During a VCUG, the child is catheterized, and a solution is injected into the bladder. This solution contains a contrasting material which will show up on the x-ray. After the solution is injected, they will take a series of pictures with an x-ray so that they can see if the contrast stays in the bladder or travels into the ureters or kidneys. If the contrast is seen moving upwards, VUR is present. Lizzie has had 2 VCUGs, and it is recommended that a child have one every 6 months to a year after being diagnosed with VUR. This is a really good article on the test and what to expect.
Another test that is frequently done (often times before a VCUG) is a renal ultrasound. The ultrasound is not invasive and is a good tool for looking at the ureters, bladder and kidneys. During the ultrasound, they will look for any abnormalities in the kidneys, such as size and/or shape, and any abnormalities in the bladder, like an enlargement or obstruction. For more details on renal ultrasound, click here.
A DMSA scan is done to evaluate the kidneys, how well they are functioning (individually) and if there is any scarring or damage to them. It will also show if there are any obstructions. It can also help monitor growth and development when compared with later testing. During this test, your child will be given an IV with a dye solution. After the infusion, you will have 2-4 hours of time to let the dye travel through the body. You might want to check with your hospital to see if there are activities or play rooms available for your child to utilize during this time. When you come back your child will lie on a machine which then takes pictures of his/her kidneys. This test is sometimes done with sedation. For more information on the DMSA scan click here. I believe that the MAG3 scan is similar to the DMSA scan and used to the same purpose. For more info on a MAG3 scan click here.
A urodynamics test is a little more complex test, and is a good diagnostic test to use when there are complications or underlying problems. The test itself is done in a similar way to the VCUG, in that the child is catheterized, and a solution is injected into the bladder. During a urodynamics study they monitor the pressures in the bladder, and look to see how the bladder is working. It will show any abnormalities in the bladder, and will measure bladder capacity along with other things. In Lizzie’s case, we did the urodynamics to see if there was a voiding dysfunction that could actually be causing her reflux. For more information on the urodynamics test, please click here.
An MRI might be done when it is suspected that a neurological problem could be causing the reflux. In rare cases, bladder dysfunction and VUR can be caused when there has been damage to the nerves in the spinal cord. This can be due to Spina Bifida Occulta, Lesions on the spinal cord, or trauma to the spine. This test is used to find any defects or abnormalities in the spine. An MRI in young children is usually done under general anesthesia. For more information on MRI please click here.