Which cystography in the diagnosis and grading of vesicoureteral reflux?

Abstract

The gold standard procedure for the evaluation of vesicoureteral reflux (VUR) is the radiographic voiding cystourethrography (VCUG); direct radionuclide voiding cystography (DRVC) is an alternative method for detecting VUR. A new imaging procedure, voiding urosonography (VUS) with contrast medium, has recently been introduced. We have carried out a comparative study of these three techniques in 157 patients (aged 6 weeks-4.7 years). VUS showed the presence of VUR in 91 of 311 renal units; VCUG detected reflux in 64 of 233 renal units, and the DRVC in 23 of 78 renal units. VCUG and VUS were compared in 118 patients, and both procedures showed the same grade of reflux in 56 refluxing units (kappa value 0.92); in six cases the reflux grade was greater at VUS than at VCUG. Seven cases of reflux detected by VUS were not identified on VCUG. VCUG did not show a grade of VUR that was higher than in VUS in any patient. In the identification of 4 degrees-5 degrees grade reflux, the sensitivity of VUS reached 100%. VUS and DRVC were found to be equally effective in the detection of VUR (kappa value 0.85). In conclusion, we found that VUS is a useful method for the diagnosis and grading of patients with VUR.

Premature Destruction of Microbubbles during Voiding Urosonography in Children and Possible Underlying Mechanisms: Post Hoc Analysis from the Prospective Study

“…In previous studies, the mean examination time for ce-VUS was between 8 and 34 minutes, depending on the contrast product and ultrasound modality used [4, 6, 12, 13]. Hence, the phenomenon of premature microbubble destruction cannot be explained by a longer examination time in our centre as compared to other groups.…”

Direct radionuclide cystography imaging in colovesical fistula due to inguinal hernia operation complication

“…Although it has higher sensitivity and specificity (86 and 91.3%, respectively), it often fails to demonstrate the fistulous tract [2,3,5,7,8]. In our case, the CT findings were evaluated as 'suspicious'.…”

“…The options include plain abdominal radiography, IVP and US examination, BE, CT, MRI and cystoscopy [3,5]. Garcea et al stated in their study that the sensitivity of plain abdominal radiography was 29%.…”

“…In the literature, the accuracy of double-contrast barium enema studies is between 20.1 and 62% [2,3,5,7,8].…”

Current management of vesicoureteral reflux in pediatric patients: a review

“…Radionuclide cystograms have also been utilized due to their lower radiation exposure and higher sensitivity; however, the anatomical depiction is less precise and does not allow for initial, highresolution grading of disease severity. 7 used to diagnose a suspected episode of acute pyelonephritis and later to assess differential renal function and the degree of renal cortical scarring 8 ( Figure 7). Urodynamic studies are only indicated in children suspected to have secondary reflux.…”