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Cyclic voiding urosonography in detecting vesicoureteral reflux in children

Gregor Novljan1, Anton Kenig, Rina Rus

  • 1Department of Pediatric Nephrology, University Medical Center Ljubljana, Children's Hospital, Stare pravde 4, 1000 Ljubljana, Slovenia. gregor.novljan@mf.uni-lj.si

Pediatric Nephrology (Berlin, Germany)
|August 5, 2003
PubMed

Insights

Cyclic echo-enhanced voiding urosonography (VUS) significantly improves the detection of vesicoureteral reflux (VUR) in children compared to the standard single-cycle method. This enhanced cyclic VUS approach offers superior diagnostic accuracy for VUR identification.

Area of Science:

  • Pediatric Urology
  • Diagnostic Imaging
  • Nephrology

Background:

  • Vesicoureteral reflux (VUR) is a common condition in children, increasing the risk of urinary tract infections and kidney damage.
  • Conventional diagnostic methods for VUR include X-ray voiding cystourethrography (VCUG) and radionuclide voiding cystography (RVC).
  • Echo-enhanced voiding urosonography (VUS) is a newer, non-irradiating imaging technique for VUR detection.

Purpose of the Study:

  • To prospectively evaluate the efficacy of a cyclic procedure for VUS in diagnosing VUR in pediatric patients.
  • To compare the diagnostic yield of cyclic VUS against the conventional single-cycle VUS method.
  • To determine if cyclic VUS offers improved sensitivity for detecting VUR, particularly higher grades.

Main Methods:

  • A prospective study involving 49 pediatric patients (aged 1.4-15.8 years) diagnosed with VUR using VUS.
  • VUS was performed using a cyclic procedure, involving bladder filling, voiding, catheter retention, and a repeat of the entire process.
  • Results from the initial cycle, second cycle, and combined cyclic procedure were compared.

Main Results:

  • The cyclic VUS procedure detected 25% more VUR cases than the conventional single-cycle VUS (P=0.049).
  • The initial VUS cycle missed 20% of refluxing renal units later identified in the second cycle.
  • Cyclic VUS identified 50% more cases of VUR grade III compared to the first cycle alone.

Conclusions:

  • Cyclic echo-enhanced voiding urosonography (VUS) demonstrates superior diagnostic performance for detecting vesicoureteral reflux in children compared to the conventional single-cycle method.
  • The implementation of a cyclic procedure in VUS significantly enhances the detection rate of VUR, including higher-grade reflux.
  • Cyclic VUS represents an improved diagnostic strategy for identifying VUR in pediatric populations.

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