Investigation of choice in Vesico-ureteric Reflux is: March 2005, September 2010, September 2012

Ans. B: Voiding cystourethrography The recommended radiographic evaluation for VUR includes a VCUG, renal-bladder ultrasonography and nuclear renal scan (DMSA). Perform VCUG and renal-bladder ultrasonography in any child with documented UTI before age 5 years, any child with pyelonephritis, and any male child with a symptomatic UTI. A renal-bladder ultrasonography may be used to screen older children with UTI. If ultrasonographic findings are abnormal, conduct fuher workup studies with VCUG to rule out VUR. During the initial workup in a patient with suspected reflux, perform the standard VCUG, which provides clear anatomic detail and allows accurate grading of the reflux degree. By filling and emptying the bladder several times (cycling) with the catheter still in the bladder, as described by Lebowitz, the yield of identifying VUR is clearly enhanced. The conventional cystography provides more anatomical accuracy than nuclear cystography; however, nuclear cystography is advantageous (used widely to monitor VUR) because of lower radiation exposure and increased sensitivity.