Voiding urosonography: the study of the urethra is no longer a limitation of the technique

Durán, Carmina; Valera, Alfons; Alguersuari, Anna; Ballesteros, Eva; Riera, Lluı́s; Martín, César; Puig, Jordi

doi:10.1007/s00247-008-1050-3

Cited by 83 publications

(41 citation statements)

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“…The safety of intravesical CE US in children has been shown with no major associated adverse effects (10), and a comparative study has shown CE US to have a diagnostic accuracy of 90% in comparison to voiding cystourethrography (11). Another application of intraluminal CE US, known as voiding urosonography, also shows potential for evaluating the urethra (12).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Antegrade Contrast-enhanced US Nephrostograms to Evaluate Ureteral Patency

et al. 2017

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Purpose:To demonstrate the feasibility of contrast material-enhanced ulrasonographic (US) nephrostograms to assess ureteral patency after percutaneous nephrolithotomy (PCNL) in this proof-of-concept study. Materials and Methods:For this HIPAA-compliant, institutional review board-approved prospective blinded pilot study, patients undergoing PCNL provided consent to undergo contrast-enhanced US and fluoroscopic nephrostograms on postoperative day 1. For contrast-enhanced US, 1.5 mL of Optison (GE Healthcare, Oslo, Norway) microbubble contrast agent solution (perflutren protein-type A microspheres) was injected via the nephrostomy tube. Unobstructed antegrade ureteral flow was defined by the presence of contrast material in the bladder. Contrast-enhanced US results were compared against those of fluoroscopic nephrostograms for concordance. Results:Ten studies were performed in nine patients (four women, five men). Contrast-enhanced US demonstrated ureteral patency in eight studies and obstruction in two. One patient underwent two studies, one showing obstruction and the second showing patency. Concordance between US and fluoroscopic assessments of ureteral patency was evaluated by using a Clopper-Pearson exact binomial test. These results were perfectly concordant with fluoroscopic nephrostogram results, with a 95% confidence interval of 69.2% and 100%. No complications or adverse events related to contrast-enhanced US occurred. Conclusion:Contrast-enhanced US nephrostograms are simple to perform and are capable of demonstrating both patency and obstruction of the ureter. The perfect concordance with fluoroscopic results across 10 studies demonstrated here is not sufficient to establish diagnostic accuracy of this technique, but motivates further, larger scale investigation. If subsequent larger studies confirm these preliminary results, contrast-enhanced US may provide a safer, more convenient way to evaluate ureteral patency than fluoroscopy.q RSNA, 2016

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Section: Discussionmentioning

confidence: 99%

Feasibility of Antegrade Contrast-enhanced US Nephrostograms to Evaluate Ureteral Patency

et al. 2017

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“…These studies demonstrate that ce-VUS is a practical unique paediatric application of US-CAs that has gained widespread acceptance over the past few years after its introduction in the mid-1990s. Initial restrictions, such as assessment of the urethra, have been overcome, and the potential to combine ce-VUS with sonographic genitography has also been demonstrated [70][71][72][73][74][75]. A recent metaanalysis of the existing literature on comparative studies of ce-VUS with voiding cystourethrography (VCUG) and direct radionuclide cystography (DRNC) confirmed the high sensitivity and specificity of this elegant nonionising imaging modality [76].…”

Section: Discussionmentioning

confidence: 99%

Application of a second-generation US contrast agent in infants and children—a European questionnaire-based survey

Riccabona

2012

Pediatr Radiol

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Background No US contrast agent (US-CA) is currently licensed for use in children.Objective To survey the off-label use in children of a second-generation US-CA. Materials and methods Questionnaires were e-mailed to European paediatric radiologists, who were asked about their experience with the second-generation US-CA Sonovue® (Bracco, Milan, Italy). Number of examinations per indication and adverse effects were recorded. Examinations were categorised by intravenous or intracavitary use of US-CA. Results Out of 146 respondents, 88 stated that they did not perform contrast-enhanced US in children, but 36 of these (44%) would appreciate paediatric approval. Fortyfive centres reported 5,079 examinations in children (age mean: 2.9 years; range: birth-18 years, M/F: 1/ 2.8). The majority (4,131 [81%] in 29 centres) were intravesical applications. The minority (948 [19%] in 30 centres) were intravenous applications. No adverse effects had been recorded from intravesical use. Six minor adverse effects (skin reaction, unusual taste, hyperventilation) had been recorded after five intravenous studies (0.52%). Conclusion Responses suggest a favourable safety profile of this second-generation US-CA in children. It also demonstrates a demand for such US-CA from paediatric radiologists.

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“…These include intravesical CEUS, which has become an option for the diagnosis of vesicoureteral reflux in pediatric patients, 25 and voiding urosonography, which shows potential for evaluating the urethra. 26 Defining novel applications for ultrasound contrast could improve diagnostic and therapeutic options for patients without incurring the exposure of ionizing radiation.…”

Section: Figmentioning

confidence: 99%

Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System

Usawachintachit

Tzou

Mongan

et al. 2017

Journal of Endourology

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Objectives: Ultrasound-guided percutaneous nephrolithotomy (PCNL) has become increasingly utilized. Patients with nondilated collecting systems represent a challenge: the target calix is often difficult to visualize. Here we report pilot study results for retrograde ultrasound contrast injection to aid in percutaneous renal access during ultrasound-guided PCNL. Patients and Methods: From April to July 2016, consecutive patients over the age of 18 years with nondilated collecting systems on preoperative imaging who presented for PCNL were enrolled. B-mode ultrasound imaging was compared with contrast-enhanced mode with simultaneous retrograde injection of OptisonÔ via an ipsilateral ureteral catheter. Results: Five patients (four males and one female) with renal stones underwent PCNL with retrograde ultrasound contrast injection during the study period. Mean body mass index was 28.3 -5.6 kg/m 2 and mean stone size was 24.5 -12.0 mm. Under B-mode ultrasound, all patients demonstrated nondilated renal collecting systems that appeared as hyperechoic areas, where it was difficult to identify a target calix for puncture. Retrograde contrast injection facilitated delineation of all renal calices initially difficult to visualize under Bmode ultrasound. Renal puncture was then performed effectively in all cases with a mean puncture time of 55.4 -44.8 seconds. All PCNL procedures were completed without intraoperative complications and no adverse events related to ultrasound contrast injection occurred. Conclusion: Retrograde ultrasound contrast injection as an aide for renal puncture during PCNL is a feasible technique. By improving visualization of the collecting system, it facilitates needle placement in challenging patients without hydronephrosis. Future larger scale studies comparing its use to standard ultrasound-guided technique will be required to validate this concept.

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Voiding urosonography: the study of the urethra is no longer a limitation of the technique

Abstract: VUS can replace voiding cystourethrography as the method of choice for the initial study of suspected VUR in children.

Cited by 83 publications

References 10 publications

Feasibility of Antegrade Contrast-enhanced US Nephrostograms to Evaluate Ureteral Patency

Feasibility of Antegrade Contrast-enhanced US Nephrostograms to Evaluate Ureteral Patency

Application of a second-generation US contrast agent in infants and children—a European questionnaire-based survey

Feasibility of Retrograde Ureteral Contrast Injection to Guide Ultrasonographic Percutaneous Renal Access in the Nondilated Collecting System

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