Usefulness of echocystography in the study of vesicoureteral reflux.

Abstract

The aim of our study was to assess the usefulness of contrast-enhanced sonography in detecting and staging vesicoureteral reflux in pediatric patients. Forty-nine children between birth and 5 years of age were studied for vesicoureteral reflux. Echocystography with the use of an endovesical signal enhancer was performed first, followed immediately by conventional voiding cystourethrography. The findings obtained by echocystography and voiding cystourethrography were consistent in 89 (90.8%) of 98 ureterorenal units (a ureterorenal unit is 1 kidney with its own ureter). Reflux was demonstrated by voiding cystourethrography in 13 cases; in 9 of these cases diagnosis had also been made by echocystography. Five cases of reflux detected by echocystography were not identified by voiding cystourethrography. With voiding cystourethrography as the standard of reference, sensitivity was 69%; specificity, 94%; positive predictive value, 64%; and negative predictive value, 95%. In conclusion, echocystography is a useful tool for the diagnosis of vesicoureteral reflux. Its ability to detect reflux is similar to that of cystography in cases of high-grade reflux, and it may be an appropriate complementary technique to voiding cystourethrography, because it avoids exposure to radiation.

Comparison of echo-enhanced ultrasound with fluoroscopic MCU for the detection of vesicoureteral reflux in neonates

“…Children with a prior diagnosis of VUR were deliberately excluded in our series. Our results are very similar to those obtained by Escape et al [11] (sensitivity 69% and specificity 94%) using MCU as the gold standard. Most of their patients were neonates.…”

“…The mean time for the voiding sonogram in the study of Farina et al [15] (excluding catheterization) was 15 min, with 33 min for the entire examination, compared to 6.35 min (mean) postcatheterization in our study. As we and other authors have noted, the concordance between the two techniques was improved when higher grades of reflux were present, and lower grades of reflux were more frequently missed with echo-enhanced sonography [1,7,11] although colour Doppler can improve detection of low-grade VUR [16].…”

“…The 15% prevalence of VUR within our study group reflects this. It has been estimated that 10-15% of cases of antenatal hydronephrosis are caused by primary VUR, with a higher incidence of VUR (20-50%) in children with a proven urinary tract infection [4,11,12,13]. In other studies evaluating echo-contrast sonography, much higher detection rates of VUR, up to 90%, have been obtained, suggesting that a highly selected population was being examined [14,15] ( Table 3).…”

“…The disadvantages of contrast-enhanced sonography include operator-dependence, rapid disintegration of the microbubbles, difficulty in grading VUR (although some authors claim variably good results) [11,14], and difficulty in examination of the male urethra [14]. Advantages of the technique are that it is safe, and more acceptable to parents, as they are able to stay close to or even feed the infant, facilitating the procedure for all.…”

Cyclic contrast-enhanced harmonic voiding urosonography for the evaluation of reflux. Can we keep the cost of the examination low?

“…Direct radionuclide cystography (DRNC) is a reliable alternative with a significantly smaller radiation dose; however, it is less available, and it has poor anatomical resolution [13,14]. Contrast-enhanced voiding urosonography (VUS) with microbubbles containing contrast medium (CM) made of galactose-palmitic acid (SH U 508 A, Levovist; Schering, Berlin, Germany) has been used for the last 10 years and has been found to be equally sensitive compared to VCUG and DRNC [15][16][17][18][19][20][21][22][23][24][25]. Harmonic imaging has been shown to be significantly better at depicting microbubbles in the ureters and pelvicalyceal system [26][27][28].…”