Investigations for Vesicoureteric Reflux in Children: Ultrasound vs. Radionuclide Voiding Cystography

Abstract

In this study, 53 children suffering from recurrent urinary tract infections were investigated both by ultrasound and direct radionuclide voiding cystography (RNVC). The findings were: Most high-grade vesicopelvic refluxes were detected by both methods consistently. Discrepant results of high-grade vesicopelvic refluxes were seen in 6 kidneys from 4 children. Main advantages of RNVC are the quick results and the ease of interpretation of these results. In RNVC the whole urinary tract can be observed during the filling phase as well as during the voiding and postvoiding phase. In sonography, the different parts of the urinary tract must be explored one after another during the filling, voiding, and postvoiding phase. The investigation by sonography is time consuming and a strongly investigator-dependent procedure.

Diagnosis of vesicoureteral reflux with ultrasonography

“…The ballooning of the renal pelvis during the filling of the bladder represented the criterion for diagnosis of VUR. Only Martin et al [26] included the detection of a dilating terminal ureter as an additional criterion. A major drawback, and one that has not been adequately addressed in these studies, is the lack of a cut-off value with regards to the renal pelvic dilatation.…”

“…The first and, in the past, most frequently administered fluid was plain physiological saline solution [24,25,26,27,28]. The ballooning of the renal pelvis during the filling of the bladder represented the criterion for diagnosis of VUR.…”

Potential role of colour-Doppler cystosonography with echocontrast in the screening and follow-up of vesicoureteral reflux

“…In the past two decades, various authors (3)(4)(5) have suggested ultrasonography (US) as an effective diagnostic procedure for identifying VUR; the use of microbubbles has improved this technique, yielding high sensitivity for grades III-IV VUR. More recent studies (6, 7) confirm the excellent results in the diagnosis of severe grade reflux, but point to an insufficient sensitivity of grade I VUR.…”

Contrast-enhanced ultrasonography (voiding urosonography) of vesicoureteral reflux: State of the art

“…Despite an elevated sensitivity for highgrade refluxes, the limited stability of the microbubbles conditioned the sonographic examination time and thus detection of low-grade or intermittent refluxes [24][25][26][27].…”

“…Nonostante un'elevata sensibilità per reflussi di grado elevato, la limitata stabilità delle microbolle, condizionava il tempo di osservazione ecografica e quindi l'evidenziazione di reflussi di grado minore o intermittenti [24][25][26][27].…”