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Vesicoureteric reflux in the adult

Department of Radiology, Adelaide and Meath Hospitals incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland

View larger version (107K): [in this window] [in a new window]   Figure 1. Micturating cystourethrogram in an adult patient with known spina bifida and deteriorating renal function. The bladder is irregular, in keeping with a neurogenic bladder. There is free reflux seen in the left ureter(arrow).

View larger version (124K): [in this window] [in a new window]   Figure 2. Adult patient with previous cystectomy and ileal conduit formation. Contrast has been infused into the ileal conduit through a Foley catheter inserted into the proximal portion of the conduit. Contrast is seen to reflux freely into the right ureter and collecting system of the right kidney.

View larger version (114K): [in this window] [in a new window]   Figure 3. Single image from a micturating cystogram in a patient post renal transplant. The transplant is located in the right iliac fossa and contrast is seen to reflux into the implanted ureter.

View larger version (154K): [in this window] [in a new window]   Figure 4. Single image from a micturating cystogram in an adult female patient who presented with recurrent urinary tract infection(UTI) demonstrated unilateral reflux with dilatation of the right ureter.

View larger version (15K): [in this window] [in a new window]   Figure 5. Diagrammatic representation of the International Reflux Grading system. Vesicoureteric reflux(VUR) is classified into five grades. (Illustration courtesy of Tony Geoghegan.)

View larger version (117K): [in this window] [in a new window]   Figure 6. Spot film from a micturating cystogram in an adult male who present with hypertension and renal impairment. Urine refluxed freely into the ureters and collecting system, and in this image the pelvis appears severely dilated and calyces are severely blunted. The ureters appear very dilated with a tortuous course.

View larger version (136K): [in this window] [in a new window]   Figure 7. Loopogram in a patient with an ileal conduit performed following cystectomy for bladder cancer. There is bilateral reflux into the ureters with evidence of ureteric dilatation and calyceal clubbing secondary to the vesicoureteric reflux(VUR).

View larger version (96K): [in this window] [in a new window]   Figure 8. Sagittal ultrasound image in the pelvis demonstrating dilated duplex ureters(arrow; left ureter) in a patient with vesicoureteric reflux (VUR). (Asterix on bladder).

View larger version (154K): [in this window] [in a new window]   Figure 9. Intravenous pyelogram(IVP) in a patient with secondary vesicoureteric reflux (VUR) due to a neuropathic extrophic bladder demonstrates calyceal clubbing as a result of VUR.

View larger version (135K): [in this window] [in a new window]   Figure 10. Intravenous pyelogram(IVP) in a patient with a horseshoe kidney shows evidence of chronic reflux nephropathy with scarring of the renal cortex, grossly dilated ureters and clubbed calyces bilaterally.

View larger version (141K): [in this window] [in a new window]   Figure 11. Post-contrast image of an intravenous pyelogram (IVP) in a patient with vesicoureteric reflux (VUR) and consequent reflux nephropathy demonstrates thinning of the upper poles bilaterally due to scarring.

View larger version (132K): [in this window] [in a new window]   Figure 12. Transverse CT image following oral and intravenous contrast in a patient with a horseshoe kidney and vesicoureteric reflux(VUR). There is dilatation of the collecting systems and scarring bilaterally.

View larger version (136K): [in this window] [in a new window]   Figure 13. Three-dimensional gadolinium-enhanced source image using a fast low-angled shot (FLASH) protocol in a patient with vesicoureteric reflux (VUR) demonstrates marked scarring of the lower pole of the right kidney. Non-enhancing simple cysts are incidentally noted in both kidneys.

View larger version (94K): [in this window] [in a new window]   Figure 14. Coronal maximum intensity projection(MIP) in a patient with a known horseshoe kidney image using a fluid-sensitive half-Fourier single-shot turbo spin-echo (HASTE) magnetic resonance urography protocol demonstrates a Foley catheter in the bladder with dilatation of both ureters and the collecting system of the kidneys in keeping with reflux disease.

View larger version (107K): [in this window] [in a new window]   Figure 15. (a) Coronal true FISP (fast imaging with steady-state precession) and (b) coronal maximum intensity projection (MIP) image of a patient with unilateral vesicoureteric reflux (VUR) that has resulted in a small, shrunken right kidney.

View larger version (147K): [in this window] [in a new window]   Figure 16. Coronal true FISP(fast imaging with steady-state precession) image of a patient with spina bifida and vesicoureteric reflux (VUR) secondary to a neuropathic bladder, as evidenced by a dilated left ureter and clubbed calyceal system.