Diagnostic Approach to Reflux in 2007

Abstract

There is ongoing controversy regarding the association between vesicoureteric reflux (VUR), recurrent urinary tract infections (UTI), and renal damage. Despite this, routine work up for VUR is still recommended after febrile UTI in most children. The present article reviews the indications and imaging modalities available for VUR diagnosis. Alternative newer techniques like MR cystography and voiding urosonography are discussed. The increasing evidence of the role of DMSA scans in managing children with VUR is highlighted.

Significance of Sonographically Demonstrated Ureteral Dilatation in Evaluation of Vesicoureteral Reflux Verified with Voiding Urosonography in Children with Urinary Tract Infection

“…Given the existence of correlation between urinary infection and VUR ( 31 ), and taking into account that ultrasound remains part of the routine evaluation of first-time UTI in the pediatric population ( 32 , 33 ), we decided to analyze the usefulness of sonographically demonstrated ureteral dilatation obtained during routine ultrasound examinations of the urinary tract in detecting VUR. Statistically significant correlation between this ultrasound parameter and the existence of VUR was observed, with relatively high sensitivity (67.2%), specificity (81.4%), and high positive (78.8%) and negative predictive value (70.6%), total diagnostic accuracy of 74.2% in detecting VUR, and significantly increased probability (20 – 25%) of detecting VUR in patients with US confirmed ureteric dilatation.…”

Surgical management of high‐grade vesicoureteral reflux in an 18‐month‐old female with a solitary kidney: A case report from a resource‐limited setting

“…However, despite the increased radiation exposure associated with it, VCUG is still a solid option because it offers more anatomic detail. Specifically, RNC does not reliably show a bladder wall appearance, or Grade I reflux 13 . The RNC also does not demonstrate urethral anatomy in boys, which may be important for secondary causes of VUR (e.g., posterior urethral valves).…”

“…Specifically, RNC does not reliably show a bladder wall appearance, or Grade I reflux. 13 The RNC also does not demonstrate urethral anatomy in boys, which may be important for secondary causes of VUR (e.g., posterior urethral valves). For this reason, in many canters, RNC was not used in the initial study but may be used to monitor for persistent reflux in follow‐up studies.…”

“…12 Radionuclide cystogram (RNC) is an alternative modality. 13 However, despite the increased radiation exposure associated with it, VCUG is still a solid option because it offers more anatomic detail. Specifically, RNC does not reliably show a bladder wall appearance, or Grade I reflux.…”