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Usefulness of echocystography in the study of vesicoureteral reflux
I Escape1, J Martínez, F Bastart
1Servei de Radiologia, Sociedad Cooperativa de Instalaciones Asistenciales Sanitarias, Hospital de Barcelona, Spain.
Insights
Contrast-enhanced sonography, or echocystography, is a useful tool for detecting pediatric vesicoureteral reflux. This method shows similar accuracy to voiding cystourethrography for high-grade reflux and avoids radiation exposure.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Radiology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Accurate detection and staging of VUR are crucial for appropriate management.
- Conventional diagnostic methods like voiding cystourethrography (VCUG) involve radiation exposure.
Purpose of the Study:
- To evaluate the effectiveness of contrast-enhanced sonography (echocystography) in diagnosing and staging VUR in pediatric patients.
- To compare the diagnostic performance of echocystography with conventional VCUG.
Main Methods:
- A study involving 49 children aged 0-5 years with suspected VUR.
- Echocystography using an endovesical signal enhancer was performed.
- Findings were immediately compared with conventional voiding cystourethrography (VCUG).
Main Results:
- Echocystography and VCUG findings were consistent in 90.8% of 98 ureterorenal units.
- Echocystography correctly identified 9 out of 13 reflux cases diagnosed by VCUG.
- Echocystography detected 5 cases of reflux not identified by VCUG, with sensitivity of 69% and specificity of 94% compared to VCUG.
Conclusions:
- Echocystography is a valuable tool for diagnosing pediatric vesicoureteral reflux.
- Its diagnostic ability for high-grade reflux is comparable to cystography.
- Echocystography serves as a useful, radiation-free complementary technique to VCUG.
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.