Testing for VUR
The most common test for diagnosing VUR is a Voiding Cystourethrogram (VCUG). Other tests that may be performed include renal ultrasound, DMSA scan, Urodynamics (or videourodynamics).
A VCUG can be a pretty scary and uncomfortable test for a child, but luckily it is a pretty quick test. Some parents have asked about using sedation for a VCUG, but most of the things that I have read discourage this, because it can effect how the bladder acts. 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 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 kidney. 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. For more information on VCUG, please click here. This is a really good article on the test and what to expect.
Another test that is frequently done (many times before a VCUG) is a renal ultrasound. During the ultrasound, they will look for any abnormalities in the kidneys or bladder, such as enlargement, or an obstruction. Lizzie has this test done about every 6 weeks to monitor her kidneys. For more details click here.
A DMSA scan is done to evaluate the kidneys. It will show if there is any damage or scarring, and how much. It will also show if there are any obstructions. This is a test that we will be doing in a few months. I believe that the DMSA scan, and the Mag 3 tests are the same type of test, using a different injection material (although I could be incorrect on that point). Click here for DMSA, and here for Mag 3.
A urodynamics test is a little more complex test. This test is not generally done unless there are complications. 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 for abnormalities in the bladder. This is a really good way to see how the bladder is functioning, and to find causes for any abnormal function. In Lizzie’s case, we did the urodynamics to see if there was a problem in her bladder that could actually be causing her VUR. What we discovered was that there was trabeculations in the bladder (thickening of the bladder wall) and that she had a grossly enlarged bladder. For more information on the urodynamics test, please click here.
