The Role of Ultrasonography in Predicting Vesicoureteral Reflux

Kovanlıkaya, Arzu; Kazam, J. Jacob; Dunning, Allison; Poppas, Dix P.; Johnson, Valerie; Brill, Paula W.

doi:10.1016/j.urology.2014.06.057

Cited by 22 publications

(24 citation statements)

References 16 publications

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“…Although a normal US cannot exclude high-grade VUR, most grades IV and V VUR are detected on US. 12,[36][37][38] Our findings are in agreement with previous reports of identifying most grades IV-V VUR on US, 12,36-38 indicating that when US findings are normal in children after a UTI, the risk of missing grades IV-V VUR is low. Therefore, we suggest a less aggressive diagnostic approach like US in the first management of children after a first UTI to identify the high-risk group for whom a further imaging workup is necessary.…”

Section: A C C E P T E Dsupporting

confidence: 90%

Antimicrobial Resistance and Diagnostic Imaging in Infants Younger Than 2 Months Old Hospitalized With a First Febrile Urinary Tract Infection

Hsu

Tsai

et al. 2016

Pediatric Infectious Disease Journal

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Section: A C C E P T E Dsupporting

confidence: 90%

Antimicrobial Resistance and Diagnostic Imaging in Infants Younger Than 2 Months Old Hospitalized With a First Febrile Urinary Tract Infection

Hsu

Tsai

et al. 2016

Pediatric Infectious Disease Journal

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“…We herein demonstrate that grade IV specificity remains high, with a significant increase in sensitivity compared to grade III, during USG use. Kovanlıkaya et al (25) indicated that, for reflux grades IV and V, RU can accurately predict the presence of reflux, with only 4.5% of grade IV patients and 0.7% of grade V patients misdiagnosed using renal bladder USG alone. In another recent study, RU was highly accurate for the prediction of VUR; the authors concluded that a normal RU largely excluded high grades (i.e., grades IV and V) in pediatric patients with UTI and mild renal scarring (21).…”

Section: Discussionmentioning

confidence: 99%

Increasing the Reliability of the Grading System for Voiding Cystourethrograms Using Ultrasonography: An Inter-Rater Comparison

et al. 2016

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BackgroundTo assess the effectiveness of the current vesicoureteral reflux (VUR) grading system according to the international classification of VUR (ICVUR) and to evaluate whether VUR grading accuracy could be improved by renal ultrasonography (RU) according to the Society for Fetal Urology (SFU) grading system.ObjectivesTherefore, this study assessed the accuracy of the current VCUG staging system by assessing inter-rater reliability among pediatric radiologists and urologists; it also evaluated whether accuracy is increased by RU without consensus (with respect to VCUG grading).MethodsFour pediatric urologists and four pediatric radiologists independently graded 120 voiding cystourethrograms (VCUGs). Middle VUR grades were divided into the following three groups: VUR consensus grade III (group 1), VUR consensus grade IV (group 3), and VUR non-consensus grades III and IV (group 2). All groups were compared with respect to hydronephrosis grade using RU.ResultsThe intraclass correlation coefficient (ICC) values ranging from 0.86 to 0.89 reflected good reliability. The lowest agreement was associated with middle grades (III and IV). A marked difference in sensitivity was observed between groups 1 and 3 (35% and 95%, respectively, P < 0.05), indexed by SFU hydronephrosis grade, suggesting that VCUG cases in group 2 (n = 16 at SFU 0 or 1) could be accepted as grade III, and SFU scores of 2, 3, or 4 could be considered grade IV.ConclusionsInter-rater accuracy could be improved at middle grades using renal ultrasonography (USG), which could promote communication between different specialists.

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“…Newer AAP guidelines from 2011 recommend that patients with normal USG should not undergo VCUG until a second UTI . However, some investigators fear the potential risk of kidney damage in children with clinically‐significant VUR when VCUG is delayed until a second UTI, but others concur with the 2011 AAP guidelines because patients with grade 4–5 VUR rarely show normal USG findings, and moderate to severe hydronephrosis is rarely detected in patients with low‐grade VUR less than 4 . In contrast, 24% of patients with high‐grade VUR show normal USG findings .…”

Section: Moves To Reduce Vcugmentioning

confidence: 99%

“…Because USG and VCUG provide important different information on the genitourinary tract, they should be considered complementary . Normal USG findings do not exclude high‐grade VUR, and have little ability to definitively diagnose VUR; thus, USG cannot replace VCUG in the diagnosis of VUR, but has a role to play in selecting patients who need VCUG …”

Section: Are There Any Alternatives To Vcug?mentioning

confidence: 99%

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

et al. 2018

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Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.

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The Role of Ultrasonography in Predicting Vesicoureteral Reflux

Cited by 22 publications

References 16 publications

Antimicrobial Resistance and Diagnostic Imaging in Infants Younger Than 2 Months Old Hospitalized With a First Febrile Urinary Tract Infection

Antimicrobial Resistance and Diagnostic Imaging in Infants Younger Than 2 Months Old Hospitalized With a First Febrile Urinary Tract Infection

Increasing the Reliability of the Grading System for Voiding Cystourethrograms Using Ultrasonography: An Inter-Rater Comparison

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

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