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Updated: Jul 5, 2026
Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition
Published on: June 21, 2024
[Imaging techniques and vesicoureteral reflux]
Ignacio Alonso Usabiaga1, Cristina Bravo Bravo, Pascual García-Herrera Taillefer
1Sección de Radiología Pediátrica, Hospital Materno Infantil Carlos Haya, Málaga, España. ialonsousa@gmail.com
Insights
Vesicoureteral reflux (VUR) diagnosis is shifting. Ultrasound is now the preferred imaging technique for pediatric VUR, moving beyond traditional methods like VCUG, with updated protocols considering prenatal diagnosis.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Nephrology
Background:
- Vesicoureteral reflux (VUR) is a common pediatric condition with ongoing debate in diagnosis and management.
- Current practices involve pediatricians, urologists, nephrologists, and radiologists.
Purpose of the Study:
- To update the use of imaging techniques for VUR diagnosis and follow-up.
- To propose a standardized work-up protocol for pediatric VUR.
Main Methods:
- Bibliographic review of VUR imaging modalities.
- Description of techniques: VCUG, ultrasound, IVU, bladder-ultrasound, DMSA, MRI.
- Presentation of expert working group experience.
Main Results:
- VUR concepts and management algorithms have evolved.
- Distinction between congenital renal lesions and acquired lesions post-UTI.
- VUR is increasingly viewed as secondary to UTI, prompting less invasive diagnostics.
Conclusions:
- Ultrasound, enhanced by technological advances, is now the primary imaging technique for pediatric VUR, surpassing VCUG.
- Prenatal diagnosis significantly impacts urinary tract anomaly management, altering work-up algorithms.
Objectives:
Although vesicoureteral reflux (VUR) is a very frequent pathology in the pediatric age and represents an important part of the activity of pediatricians, pediatric urologists, nephrologists, and radiologists, yet there is controversy about its global management both in diagnosis and treatment. The objective of this paper is to perform an update in the use of different imaging techniques in the diagnosis and followup of VUR and to propose a work up protocol.
Methods:
We describe the imaging techniques: VCUG, ultrasound, intravenous urography, bladder-ultrasound, DMSA, MRI, and their role in the evaluation and followup of VUR. We performed a bibliographic review about the topic and present the experience of our working group on VUR.
Results:
The bibliographic review shows a clear evolution of the concepts of VUR and also the management algorithms. The concepts of congenital renal lesion without urinary tract infection (UTI) or acquired lesion after UTI are clearly differentiated in the most recent reviews. Reflux is passing from being the center of the problem to a secondary phenomenon in relation to UTI, and this is leading to a change of diagnostic strategy, less and less invasive.
Conclusions:
VCUG has been to date the first and indisputable technique for the management of VUR, mainly in the diagnostic phase, but technological advances in the area of ultrasound (ultrasound contrasts, harmonic image, etc.) have converted ultrasound in the first imaging technique for the management of VUR in pediatric age. On the other hand, work-up algorithms have changed due to the great impact prenatal diagnosis is having in the management of urinary tract anomalies.
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