Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection

J Urol. 2004 Sep;172(3):1071-3; discussion 1073-4. doi: 10.1097/01.ju.0000135337.71154.60.


Purpose: We study the ability of dimercapto-succinic acid (DMSA) scintigraphy to predict the presence of dilating vesicoureteral reflux (VUR) in infants with urinary tract infection (UTI) to simplify the evaluation protocol.

Materials and methods: A retrospective analysis of the records of 303 children younger than 2 years with initial UTI investigated with DMSA scintigraphy and voiding cystourethrography (VCU) within 3 months after UTI was performed.

Results: In 156 of the 303 children (51%) DMSA scintigraphy showed renal lesions. VUR was found in 80 patients (26%) and VUR grade significantly correlated with the presence of renal lesions. A normal DMSA scintigraphy and dilating VUR (grade III) occurred in 7 infants. At followup after 1 to 2 years, 6 of these 7 patients had normal DMSA scans and 1 had a scarred duplex kidney. VUR resolved spontaneously in 5 and improved spontaneously to grade 1 in 2 patients. None of the 7 children had recurrent UTI.

Conclusions: DMSA scintigraphy in infants with UTI may replace VCU as a first line investigation. A strategy to perform VCU in only patients with renal lesions is proposed. In this study 147 of 303 VCUs would have been unnecessary as only 1 child with a damaged kidney was missed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Kidney / diagnostic imaging*
  • Male
  • Radionuclide Imaging
  • Radiopharmaceuticals*
  • Technetium Tc 99m Dimercaptosuccinic Acid*
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / diagnostic imaging*
  • Urography
  • Vesico-Ureteral Reflux / complications
  • Vesico-Ureteral Reflux / diagnostic imaging*


  • Radiopharmaceuticals
  • Technetium Tc 99m Dimercaptosuccinic Acid