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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography

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The role of ultrasonography in predicting vesicoureteral reflux

Arzu Kovanlikaya1, Jacob Kazam2, Allison Dunning3

  • 1Division of Pediatric Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY.

Urology
|December 3, 2014
PubMed

Insights

Renal and bladder ultrasonography (RBU) accurately screens for vesicoureteral reflux (VUR) in children. Normal RBU is rare in high-grade VUR, making it a valuable tool for selecting patients for voiding cystourethrography.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Urology

Background:

  • Vesicoureteral reflux (VUR) is a common condition in infants and children, often diagnosed via voiding cystourethrography (VCU).
  • Renal and bladder ultrasonography (RBU) is a non-invasive imaging technique used in the evaluation of urinary tract infections and VUR.

Purpose of the Study:

  • To assess the diagnostic accuracy of RBU in predicting VUR in pediatric patients.
  • To determine if RBU can reliably identify children who require further investigation with VCU.

Main Methods:

  • A retrospective study included 134 children with confirmed VUR on VCU and prior RBU.
  • VCU served as the gold standard for VUR diagnosis; RBU findings (hydronephrosis, ureteral visualization) were analyzed.
  • Diagnostic accuracy metrics (sensitivity, specificity, PPV, NPV) were calculated for RBU in predicting VUR.

Main Results:

  • A significant association was found between VUR grade and hydronephrosis severity (P = .0032).
  • RBU demonstrated higher sensitivity and negative predictive value for detecting high-grade VUR (IV-V).
  • RBU showed consistently high specificity across all VUR grades, indicating its utility as a screening tool.

Conclusions:

  • Normal RBU is uncommon in severe VUR (grades IV-V), while hydronephrosis is rare in lower grades (
  • RBU is a valid screening test to identify infants and children with a first urinary tract infection who need VCU.
  • Utilizing all degrees of hydronephrosis on RBU minimizes delays in diagnosing high-grade VUR.
Abstract

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