Diagnosis of vesicoureteral reflux with ultrasonography

The primary diagnostic procedure for evaluation of vesicoureteral reflux (VUR) in children is fluoroscopic voiding cystourethrography (VCUG). Radionuclide cystography (RNC) is an alternative, sensitive method for diagnosing VUR, but it lacks spatial resolution. Over the past 2 decades, in an effort to eliminate the radiation exposure intrinsic to these methods, many endeavors had been made to use ultrasonography (US) for the diagnosis of VUR. The various attempts that have been undertaken are reviewed. The real breakthrough in the US diagnostic option has come with the availability of stable US contrast media that can be administered intravesically. Comparison between contrast-enhanced sonographic reflux examination (voiding urosonography, VUS) and VCUG/RNC has revealed the high concordance between these imaging modalities regarding the diagnosis or exclusion of VUR. Imaging of the urethra still necessitates the performance of VCUG. VUS is used in routine imaging primarily for follow-up cases, girls, and screening high-risk groups for reflux. Using these selection criteria, the number of VCUG investigations can be reduced by over half and, consequently, a significant reduction of radiation exposure in children can be achieved. With the emergence of harmonic US imaging, the sonographic reflux examination will gain further diagnostic potential and widespread application. The whole field of sonographic diagnosis of reflux is still in the process of rapid development.