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IntroductionUltrasonography, or renal ultrasound, is a noninvasive medical imaging technique that uses high-frequency sound waves to visualize the kidneys, ureters, bladder, and surrounding tissues.Indications for Urinary System UltrasonographyUrinary system ultrasonography is indicated in various clinical scenarios, such as:Kidney Stones (Urolithiasis): To detect and monitor the size and presence of kidney or urinary tract stones.Hydronephrosis: To assess the dilation of the renal pelvis and...
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Evaluation of Biomaterials for Bladder Augmentation using Cystometric Analyses in Various Rodent Models
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Voiding cystourethrogram: Who gets a cyclic study and does it matter?

Angela M Arlen1, Jay Amin1, Traci Leong2

  • 1Department of Urology, Yale School of Medicine, New Haven, CT, USA.

Journal of Pediatric Urology
|March 4, 2022
PubMed
Summary
This summary is machine-generated.

Cyclic voiding cystourethrogram (VCUG) is crucial for diagnosing intermittent vesicoureteral reflux (VUR), especially in younger children. Performing multiple cycles ensures accurate VUR detection, preventing missed diagnoses and identifying significant reflux cases.

Keywords:
ProtocolVesicoureteral refluxVoiding cystourethrogram

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Area of Science:

  • Pediatric Urology
  • Diagnostic Imaging
  • Radiology

Background:

  • Voiding cystourethrogram (VCUG) visualizes the bladder and urethra, and ureters/kidneys if vesicoureteral reflux (VUR) is present.
  • Standardized VCUG protocols recommend at least two voiding cycles to detect intermittent VUR and ureteral ectopia.
  • Variations in VCUG techniques necessitate adherence to standardized protocols for accurate diagnosis.

Purpose of the Study:

  • To assess adherence to cyclic VCUG protocols in pediatric patients.
  • To compare outcomes and radiation dosage between cyclic and single-cycle VCUG evaluations.
  • To determine the diagnostic yield of multiple voiding cycles for detecting VUR.

Main Methods:

  • Retrospective analysis of 284 VCUG studies, excluding patients over 18 or those with trauma evaluations.
  • Comparison of children who underwent cyclic VCUG versus single-cycle VCUG.
  • Analysis of radiation dosage in relation to the number of VCUG cycles performed.

Main Results:

  • 26 children (9.2%) were diagnosed with VUR only after an initial negative cycle, representing 21.2% of all VUR cases.
  • Younger children (<1 year) were significantly more likely to undergo cyclic VCUG (74.1%) compared to older children (>5 years) (6.9%).
  • Cyclic VCUG studies were associated with a lower median radiation dose (2.15 microGy m2) compared to single-cycle studies (4.41 microGy m2).

Conclusions:

  • Adherence to cyclic VCUG protocols is essential for accurate VUR diagnosis, as 21.2% of VUR cases were identified after the initial cycle.
  • Younger children benefit most from cyclic VCUG, with higher detection rates of potentially significant dilating reflux.
  • Cyclic VCUG enhances diagnostic accuracy without increasing radiation exposure, supporting the standardized protocol.