Value of sonography in the diagnosis of mild, moderate and severe vesicoureteral reflux in children

Department of Radiology and Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/2013; 24(2):297-302. DOI: 10.4103/1319-2442.109582
Source: PubMed


This study was conducted to determine the positive predictive value (PPV) of gray scale sonography in the diagnosis of mild, moderate and severe vesicoureteral reflux (VUR). This cross-sectional descriptive analytic study was conducted in the University Clinic of Isfahan University of Medical Sciences in 2008. The study was performed on children aged two to 12 years; female children with febrile urinary tract infection (UTI) and clinical suspicion of VUR and males with history of UTI and VUR who attended follow-up during the six months study period were selected. Non-cooperative patients were excluded from the study. A total of 90 patients were studied. The data gathering method was sequential. The following sonographic parameters were assessed in all the study patients: antero-posterior pelvic diameter, distal ureteric diameter and stasis of urinary system, which were measured at rest and during and after the Valsalva maneuver. Also, the vesicoureteral junction distance and distance of vesicoureteral junction to the midline were measured on both sides at rest. We then referred them for radionuclide cystography (RNC) and the results of the two methods were compared. Data were analyzed with SPSS program and t-test and chi square formulas were used. The sensitivity of ultrasound in the diagnosis of VUR was 70.9% and the specificity was 51.4%. Thus, the PPV was 69.64% and the negative predictive value was 52.94%. Although the most definite diagnosis of VUR is made with micrurating cystoureterography or RNC, sonography may be used as the first step in evaluation for VUR, especially in high-grade VUR.

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    • "Ultrasonography now plays a valuable role in the diagnosis of VUR, however the most definite diagnosis of VUR is made with VCUG or radionuclide cystography (RNC), sonography may be used as the first step in evaluation for VUR, especially in high-grade VUR [23]. Recently Duran and his colleagues proposed the use of Voiding Ultrasonography (VUS) as US examination using US contrast agent (microbubbles) as part Fig. 4 Duplicated left collecting system with non-functioning obstructed ectopic upper moiety ureter. "
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    ABSTRACT: Our aim was to determine the feasibility, accuracy and diagnostic potential of combined static-excretory MR Urography in children with sonographically detected hydronephrosis. We prospectively evaluated 28 children (11 girls and 17 boys), mean age 8.3 years (range 2 months to 16 years). Static-excretory MR Urography was performed in all cases. The results of MR urography were compared with the results of other imaging modalities, cystoscopy and surgery. In 28 children, 61 renal units were evaluated by MR urography (the renal unit is the kidney and its draining ureter). The final diagnoses included: normal renal units (n=23); uretropelvic junction obstruction (n=14); megaureter (n=8); midureteric stricture (n=1), complicated duplicated systems (n=5), post ESWL non obstructive dilation (n=2), extrarenal pelvis (n=4), dysplastic kidney (n=4). Complex pathology and more than one disease entity in were found in 7 children. The MRI diagnosis correlated with the final diagnosis in 57 units, with diagnostic accuracy 93.4%. In conclusions static and excretory MRU give both morphological and functional information in a single examination without exposure to ionizing radiation and iodinated contrast agent. It is a valuable imaging technique for children with upper urinary tract dilatation; especially in cases of complex congenital pathologies and severely hydronephrotic kidney.
    Journal of Advanced Research 01/2014; 6(2). DOI:10.1016/j.jare.2014.01.008
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    ABSTRACT: AimThis study evaluated whether sex, clinical variables, laboratory variables or ultrasonography predicted the presence of vesicoureteric reflux during the first episode of urinary tract infection in paediatric patients. We also aimed to define the criteria that indicated the need for voiding cystography testing.Methods We used voiding cystography to investigate 200 patients who experienced their first urinary tract infection at our institution between 2004 and 2013 and retrospectively analysed the data by reviewing their medical records.ResultsSex (P = 0.001), peak blood C-reactive protein levels (P < 0.001), the duration of fever after antibiotic administration (P = 0.007) and the ultrasonography findings grade (P < 0.001) were significantly different between patients with and without vesicoureteric reflux. Grade IV–V ultrasonography findings and C-reactive protein levels of ≥80 mg/L predicted vesicoureteric reflux with a sensitivity, specificity and odds ratio of 47.8%, 87.8%, and 6.59 (95% confidence interval = 3.26–13.33), respectively (P < 0.001).Conclusion Voiding cystography should be performed for patients with C-reactive protein levels of ≥80 mg/L and grade IV–V ultrasonography findings, but is not necessary in patients with C-reactive protein levels of <80 mg/L and grade I–III ultrasonography findings.This article is protected by copyright. All rights reserved.
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    ABSTRACT: To report the procedure, postoperative outcome and complications of a new technique for ureteral implantation by means of a three-stitch ureteroneocystostomy in dogs. Clinical records of dogs requiring ureteral implantation between April 2007 and June 2013 were retrospectively reviewed. Data retrieved included signalment, preoperative biochemistry results, details of the surgical procedure, perioperative and postoperative complications, postoperative biochemistry results and outcome. Nine dogs fulfilled the inclusion criteria. Follow-up times ranged from 10 to 79 months (median 30 months), with 8 of 9 dogs having an excellent long-term outcome and no major postoperative complications. One dog with follicular cystitis as a comorbidity developed obstruction from inflammatory granuloma and required revision surgery. The three-stitch technique for ureteral implantation compares favourably to previously documented techniques in terms of outcome and complication rates. Reduced tissue handling and a decreased volume of suture material may be beneficial for healing. The technique is also faster than previously described options, which may be of benefit in unstable patients requiring ureteral implantation due to traumatic injury or rupture. © 2015 British Small Animal Veterinary Association.
    Journal of Small Animal Practice 07/2015; 56(9). DOI:10.1111/jsap.12388 · 1.09 Impact Factor