The object of this presentation is threefold: first, to show the capabilities of the cinefluorographic method in evaluating lower urinary tract disease in children and adults, incidentally discussing the method of accomplishing such an examination; second, to review vesicoureteral reflux as an entity by case presentation and thus illustrate the advantages of the cine method ; third, to present some suggested clues to vesicoureteral reflux offered by observation of the excretory urogram or retrograde study. Method A 16-mm. synchronized motion picture camera with an 8-inch amplifier and a film exposure speed of 7.5 frames per second was used for all the cineradiographic studies. The exposure factors depend upon the patient's size and are in general adjusted automatically by photocell circuitry. Upon these the r-output to the individual is obviously dependent. Individual and phantom readings and calculations of gonadal dose indicate an average range of 1.1 r, plus or minus 25 per cent. This compares favorably—and is rather consistently somewhat less—with the dose from a conventional examination by a series of 5 films with every effort to minimize the amount of irradiation. The small field size is also in favor of the amplifier and cinefluorographic method in this respect. All determinations are notably limited in accuracy by the multiple factors emphasized by Morgan (1). Early attempts were made with media introduced into the bladder by excretory urography to avoid irritation of the urethra when a urethral problem was anticipated. This was satisfactory, but from a practical point of view we have concluded that a small catheter does not cause sufficient irritation or alteration in urethral physiology to be of significance. The opaque material has therefore been introduced in this manner in the majority of our cases. Establishment of good patient rapport preceding the examination is of extreme importance in avoiding emotional factors interfering with micturition at the desired time. The opaque material is any one of the readily available intravenous injectable water-soluble media diluted to a 15 per cent solution of iodine. This has proved to be completely non-irritating. Lowspecific-gravity Lipiodol has been useful in certain cases in demonstrating reflux after a twenty-four-hour bladder retention, and we are at present combining 5 c.c. of that preparation and 5 c.c. of hyperbaric Lipiodol with the water-soluble medium. This creates an “opaque sandwich,” with oily media above and below the water-soluble material, affording the advantages of oily media for visualization of the urethra without the dangers and disadvantages associated with their use in ascendant urethrography (2, 3). Filling is accomplished to the point of full sensation on the part of the patient, but not beyond this. There have been no complications in the form of temperature elevation or other manifestations of untoward reaction.
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Gross et al. (1961) studied this question.