Comparative study of conventional urosonography without contrast enhancement and x-ray voiding cystourethrography for diagnosis of vesicoureteral reflux in children

Background:Vesicoureteral reflux is the most common urinary congenital anomaly in children.Given the risk associated with radiation exposure there has been an increasing need for radiation-free method in the diagnosis and follow-up of the vesicoureteral reflux.The aim of our study is to compare conventional urosonography without contrast enhancement and x-ray voiding cystourethrography.Patients and Methods:Children with recurrent urinary tract infection with suspected vesicoureteral reflux were included to the study.Vesicoureteral reflux is demonstrated and graded by x-ray voiding cystourethrography.DMSA is used for the evaluation of renal scar.Conventional sonographic procedure was performed in all patients.Ureterovesical junction insertion angle was evaluated.The diameter and length of the ureterovesical junction were also measured.Results:268 children enrolled to the study.Vesicoureteral reflux was demonstrated in 62 children by x-ray voiding cystourethrography.Ureterovesical junction insertion angle measurement had a statistically significant relation for right and left vesicoureteral reflux presence(right:r:.646,p:.01 and left:r:.446,p:.01).Diagnosis sensitivity of vesicoureteral reflux with conventional ultrasonography is 95.10%and specificity is 81%(Youden’s index 76.1%)for the cutoff value of the ureterovesical junction insertion angle is 28.6 degrees.Positive predictive value is 87.2%,negative predictive value is 94.73%and diagnostic accuracy is 86.29%with conventional ultrasonography.Conclusions:Measurement of ureterovesical junction insertion angle,length and diameter by conventional urosonography is an easy accessible and cheap technique with high sensitivity and specificity for the diagnosis and followup of the vesicoureteral reflux without exposure to ionizing radiation.

Are DMSA Scans Reliable for Diagnosing Vesicoureteral Reflux in Infants and Children?

A retrospective study for data record of 106 patients subjected to voiding cystourethrogram test (VCUG), sonography test, and dimercaptosuccinic acid (DMSA) scintigraphy take place at King Abdulaziz University, radiology department to find out the possibilities of detecting vesicoureteral reflux (VUR) in infants and children. Hydronephrosis & Renal pelvis dilatation were the highest frequency reason for VUR scan study and represent 36% of the overall cases with 53% positive finding, while Recurrent UTI frequency was 22.6% with 83% positive finding, and patients who had history of VUR come at the third place with 15% frequency and 81% positive finding. VUR was found in 65 of 106 children representing 61%. Male children are more likely to diagnostic with VUR than female and they represented 69% while 31% for female. Among the children with VUR, 39 had high-grade reflux (grade IV or V), while 26 had low-grade reflux (grades I, II or III). When we classified VUR into low-grade and high-grade, we found the majority of children with high-grade VUR had an abnormal DMSA and represented 77.4%, while 13 children with low-grade VUR had normal study. These studies are agreed with the present study;most children with normal DMSA scan finding had low grade reflux. In this study, 48 of 65 children (74%) the DMSA scintigraphy shows abnormal findings during the period of UTI while the VCUG scan study shows VUR in 75% of the children during the period of UTI. Comparing results of ultrasound and VCUG scan, 59% of the ultrasound findings gave the same result as VCUG in detecting the VUR in children. Then we confirm it all with the urine culture results of the same children. We found the majority of children with VUR had abnormal US finding during the period of UTI and represented 83%.