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

Abstract

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.