Investigation of choice to demonstrate vesico ureteral reflux
B i.e. Contract MCU - Patients with suspected urolithiasis (stone) present with painful hematuria and /or recurrent UTI. Ultrasound and KUB X-ray are the initial screening modalityQ followed by unenhanced (i.e. non contrast) helical or spinal CT (imaging modality of choice) if screening is negative. However, IVU (intravenous urography) or IVP is still the best investigation if CT is not available. The test of choice at most centers for diagnosing an acute stone is a non contrast helical CT ScanQ. Helical CT (Non contrast) has the advantage of detecting uric acid stones in addition to the traditional radioopaques stones, and CT does not expose the patient to the risk of radio contrast agents. - Calcification is best detected by CTscanQ. MRI and PET scan have no role in diagnosing renal stone. Intravenous urography (IVP) is the only method which can detect early renal tuberculosis and papillary necrosis. It is the most sensitive and investigation modality of choice for early renal TB. However in advanced cases it should be integrated with cross sectional CT imagesQ. Micturating/Voiding cystourethrography is the best method to visualize posterior urethra, posterior urethral valve & vesico ureteric refluxQ. In post urethral valve,Voiding Cystourethrogram (VCU) shows dialation of prostatic urethra & filling defect corresponding to the valve. VU Reflux occurs when urinary bladder contracts so contrast studies of urinary bladder done during micturation is best way to see VU Reflux. Radionucleotide cystogram is Inv of 2nd choice. It's advantage is that it avoids the need for bladder catheterization. The disadvantage is its lack of anatomical detail. So it may be useful in follow up (not initial assessment).
Isotope cystogram
Contrast Micturating Cysto Urethrogram
IVP
Cystoscopy