Diagnostic imaging of vesicoureteral reflux

The diagnostic imaging modalities for vesicoureteral reflux in children comprise both radiologic and sonographic methods. The radiologic methods are voiding cystourethrography and radionuclide cystography. Voiding cystourethrography is the commonest imaging modality for reflux. With the introduction of pulsed fluoroscopy the radiation exposure of this examination is significantly curtailed. It is the imaging of first choice of the urethra. Various sonographic methods of reflux examination had been tried in the past. The real breakthrough came with the availability of stabilized US contrast media. The diagnostic accuracy of contrast-enhanced voiding urosonography has been found to be comparable to the radiologic methods. With the emergence of harmonic imaging the potential for significant improvement of the sonographic method has been achieved. Voiding urosonography is primarily performed in follow-up studies and as the first reflux examination in girls.