Redionudide cystography, direct (DRC) and indirect (IRC), has been used to detect vesicoureteric reflux (VUR) for years. DRC is generally performed in female children who do not have bladder control and requires the introduction of a urinary catheter. IRC is more physiological, avoids bladder catheterization and allows estimation of renal function as well as assessment of VUR. The intermittent nature of VUR and absence of a gold standard to confirm it however make comparisons between various diagnostic techniques difficult. Further, negative finding on IRC in children with a dilated renal pelvis does not completely rule out reflux. In this report, the authors have described the detection of VUR on DRC in a 7-year-old girl with a dilated pelvicalyceal system in whom IRC was normal on two previous occasions. The case hiohliqhts the need to perform both IRC and DRC or just the latter only in patients with pelvic dilatation and strong clinical suspicion for VUR.
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