TOACS FCPS Station · VCUG for Vesicoureteral Reflux

📷 Voiding Cystourethrogram (VCUG)

VCUG showing vesicoureteral reflux, contrast in ureters and renal pelvis

Figure 1 · VCUG · Vesicoureteral Reflux – Grade III

🔍 Key radiographic features:

✓ Contrast reflux from bladder into ureter(s) and renal pelvis
✓ Bilateral involvement (both ureters show contrast)
✓ severe ureteral dilation and calyceal blunting – consistent with Grade IV
✓ gross tortuosity
✓ Normal urethral anatomy

📋 Clinical scenario (examiner prompt)

A 3‑year‑old girl presents with a history of recurrent febrile UTIs (3 episodes in the past year). She has no daytime symptoms, but her mother reports constipation since age 2. A voiding cystourethrogram (VCUG) is performed. The image shows bilateral reflux of contrast into the ureters and renal pelves with mild dilation of the ureters and blunting of the calyceal fornices.

Recurrent UTIs Bilateral VUR Mild ureteral dilation Constipation

🧑‍⚕️ Examiner tasks · TOACS

1. Identify the diagnosis from the VCUG and clinical history.

2. Grade the VUR based on the International Reflux Study classification.

3. Discuss the pathophysiology (incompetent ureterovesical junction, flap-valve mechanism).

4. Outline management (antibiotic prophylaxis, treatment of BBD, surgical options).

⚠️ Key concept: The International Reflux Grading System is used to classify VUR severity. Grade III is defined as mild to moderate dilation of the ureter and calyces with blunting of the fornices, but without gross tortuosity (which would be Grade IV‑V). Spontaneous resolution occurs in ~50% of Grade III cases.

🎯 Expected answers (for examiners)

• Diagnosis: Bilateral vesicoureteral reflux (VUR)
• Grading: Grade IV (moderate dilation of ureter and calyces, blunting of fornices)
• Pathophysiology: Short/absent submucosal ureteral tunnel → incompetent flap-valve mechanism
• Management: Antibiotic prophylaxis (TMP-SMX), treat constipation (BBD), consider endoscopic injection if breakthrough infections

⚡ Quick FCPS‑style MCQ

VCUG shows bilateral contrast reflux into mildly dilated ureters and calyces with blunting of fornices. This is:

A. Grade I VUR B. Grade II VUR C. Grade III VUR D. Grade IV VUR

Grade	Ureter	Calyces
I	Only ureter	Normal
II	Ureter + pelvis	Normal
III	Mild-moderate dilation	Blunted fornices
IV	Grossly dilated	Moderate blunting
V	Massive/tortuous	Marked, papillary loss

🩻 TOACS FCPS Station · VCUG for Vesicoureteral Reflux (VUR)

📷 Voiding Cystourethrogram (VCUG)

🧑‍⚕️ Examiner tasks · TOACS

📌 Topic summary ·