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Ultrasonography for the detection of ureteric reflux in infants with urinary infection
M Hiraoka1, G Hashimoto, S Hayashi
1Department of Pediatrics, Fukui Medical School, Japan.
Insights
Ultrasonography effectively screens infants for ureteric reflux during their first febrile urinary infection. This less invasive method identifies significant reflux, reducing the need for voiding cysto-urethrography.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Voiding cysto-urethrography (VCUG) is the standard for detecting significant ureteric reflux (UR).
- Less invasive methods are sought to reduce radiation exposure and discomfort in infants.
- Febrile urinary infections in infants can indicate underlying renal abnormalities like UR.
Purpose of the Study:
- To evaluate the efficacy of ultrasonography (US) in identifying significant ureteric reflux in infants.
- To determine if US can serve as a screening tool for UR in infants with their first febrile urinary infection.
Main Methods:
- Prospective study of 27 infants (0-8 months) with their first febrile urinary infection.
- Urinary tract scanned using US during full bladder, before and during induced voiding.
- Infants with abnormal US findings or recurrent infections underwent VCUG.
Main Results:
- Ten infants underwent VCUG; eight refluxing ureters were identified in six boys.
- US showed transient renal pelvis dilatation (5 kidneys) and distal ureter dilatation (12 kidneys) during voiding.
- Pelvic dilatation on US correlated with high-grade UR (III or IV); only one infant without US screening had recurrent infection and UR.
Conclusions:
- Ultrasound scanning during voiding is effective for screening infants with febrile urinary infection.
- US can identify significant ureteric reflux, potentially avoiding invasive procedures like VCUG.
- This approach reduces unnecessary invasive examinations for infants with no significant UR.
Abstract:
Several less harmful methods than voiding cysto-urethrography for detecting significant ureteric reflux have been proposed. The present prospective study investigated whether ultrasonography was effective in identifying ureteric reflux in infants with their first febrile urinary infection. The subjects were 27 infants (24 boys and 3 girls) aged from 0 to 8 months. The urinary tract was scanned when the bladder was full, and before and during induced voiding. Infants with abnormal ultrasound findings underwent voiding cysto-urethrography. The other infants were followed and those who had a recurrence of urinary infection underwent voiding cystography. Ten children underwent cysto-urethrography, with eight refluxing ureters identified in six boys. Ultrasound revealed transient dilatation of the renal pelvis on voiding in five kidneys, transient dilatation of distal ureters in 12 and hydro-ureteronephrosis in two. Each of the five kidneys with pelvic dilatation on voiding was associated with ureteric reflux grades III or IV. Of the 17 children who did not undergo cysto-urethrography, only one had recurrence of urinary infection and was diagnosed with ureteric reflux. This girl was one of the three babies who were not scanned during voiding. More than half of the infants with febrile urinary infection were excluded from invasive examination without having recurrence of urinary infection. Thus, ultrasound scanning during voiding was effective for screening infants with their first urinary infection to detect significant ureteric reflux.