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

Abstract

Objectives:The aim of this study was to determine sensitivity, specificity, and predictive values of sonographically demonstrated ureteral dilatation in detecting vesicoureteral reflux (VUR).Methods:Ethical approval from the Ethical Committee of Clinical Center University of Sarajevo and parental consent were obtained for this prospective study involving 120 children with history of urinary tract infections (UTIs). Ultrasound examination included the evaluation of the urinary tract, with a special emphasis on evaluation of ureteral dilatation. Voiding urosonography (VUS) was carried out according to a standard protocol with the use of ultrasound contrast agent Sono Vue of second generation. Ureteral diameter greater than 3 mm was considered pathological. Proven VUR was graded into one of three stages.Results:Infectio tracti urinarii recidivans was referral diagnosis in the majority of patients. The average age of patients was 4.33 ± 3.88 years (from 2 months to 16 years of age). VUS findings were normal in 59 (49.2%), and pathological in 61 (50.8%) patients. Statistical analysis showed significant correlation between type and grade of VUR. Our data confirmed predominance of VUR in females and in children under the age of 5. Statistically significant correlation between ureteral dilatation and the existence of VUR was found, 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 sonographically confirmed ureteral dilatation.Conclusion:Sonographically confirmed ureteral dilatation can be used as a predictor of VUR in children with UTIs, and in combination with other predictors, might find a place in an evidence-based selective strategy in children with suspected VUR.

Contrast‑enhanced voiding urosonography with intravesical administration of ultrasound contrast agent for the diagnosis of pediatric vesicoureteral reflux

“…In the present study, children who were demonstrated to be negative for VUR by CeVUS examination were also negative for VUR in the VCUG examination, while 2 children who were determined to be negative for VUR by VCUG were later diagnosed with unilateral Grade III VUR using CeVUS scanning. These results are consistent with a previous study ( 23 ) and suggest that VCUG is not sensitive enough to diagnose Grade III VUR due to its intermittent scanning ( 19 ).…”

The relationship between urinary tract infection and Vesicourethral reflux in children from eastern galilee region-israel

“…But others believe that VCUG must be done as soon as possible. After VUS is introduced, the number of VCUG investigations were reduced by over half and, consequently, a significant reduction of radiation exposure in children can be achieved [22][23][24][25][26][27].…”

“…At Baruch-Padeh Poria Medical Center, we are performing all these imaging tests as following: In children with age less than half year, renal US is recommended during admission or nearby. If the ultrasound is abnormal and if there is no response to treatment with antibiotics during 48 hrs, VCUG must be performed during the coming two weeks [24][25][26][27], and renal scan 3 to 5 months after the UTI [28]. Children with age above half year, ultrasound will be performed first, and renal DMSA scan few months later [26][27][28][29].…”

“…VCUG is the method of choice for diagnosis of VUR. The timing of VCUG is controversial [23][24][25]. Many researchers suggest postponing the VCUG until 4-6 weeks after treatment.…”