BERKELEY, CA (UroToday.com) - Dr. Antonio Piscitelli, et al. from Italy evaluated the use of voiding urosonography in the detection of vesicoureteral reflux. They compared a voiding urosonography with a direct radionuclide voiding cystography and standard radiographic voiding cystourethrography for the evaluation of vesicoureteral reflux. They studied 157 patients with these three techniques.

The group found that voiding ultrasonography showed the presence of reflux in 91 of 311 renal units where VCUG detected reflux in 64 of 233 renal units while the radionuclide cystography in 23 of 78 renal units. They then compared a standard VCUG and voiding ultrasonography in the 118 patients and both procedures showed the same grade of reflux in 56 refluxing units. They noted that in six of these 118 cases the grade of reflux was diagnosed higher with voiding ultrasonography than the standard VCUG. They further noted that 7 of these 118 cases of reflux was detected by voiding ultrasonography and not identified on the standard VCUG. When the group evaluated higher grades of reflux, in particular Grade IV and V vesicoureteral reflux, they found that the sensitivity of the voiding ultrasonography reached 100%. They then decided to evaluate the overall efficacy of voiding ultrasonography comparing it to the more sensitive radionuclide cystography. They found that both were equally affected at detecting vesicoureteral reflux. The group concluded that voiding ultrasonography with a contrast medium which has recently been introduced to help diagnose and follow vesicoureteral reflux is a useful method for diagnosing and grading patients with reflux.

The most difficult part of following vesicoureteral reflux is repeated VCUG studies. We constantly need to envision and head towards a more minimally invasive approach to caring for kids with vesicoureteral reflux. Voiding ultrasonography is one important avenue for continued exploration. Also utilizing DMSA scans to truly see which of these children are at risk for renal scarring might be of value as well. It is not unforeseeable that dynamic MRI studies with gadolinium can probably have some potential in following these children without requiring repeated catheterizations.

Piscitelli A, Galiano R, Serrao F, Concolino D, Vitale R, D'Ambrosio G, Pascale V, Strisciuglio P

Pediatric Nephrology 23(1):107-110, Jan 2008
10.1007/s00467-007-0651-7

PubMed Abstract
PMID: 17987321

UroToday.com Pediatric Urology Section

Written by Pasquale Casale, MD, a Contributing Editor with UroToday.

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