Something old, something new: The contrast-enhanced voiding urosonography in the diagnosis of vesicoureteral reflux
Number:28ESURABS0090
Type:Educational Electronic Presentation
Authors: Mafalda Machado, Rute Martins, Ana Sofia Moreira, Matilde Gonçalves, Henrique Patrício
Keywords:contrast-enhanced voiding urosonography; ceVUS; vesicoureteral reflux; VUR
SECTIONS
Educational objective

To review and describe the emerging technique of contrast-enhanced voiding urosonography (ceVUS), its advantages and limitations, and its utility to evaluate and grade vesicoureteral reflux and other urological pathologies in pediatric patients.

 

Topic Review

Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder to the upper urinary tract and has an estimated incidence of 1% in newborns. VUR is the most frequent urological pathology in the pediatric age and is an important risk factor for reflux nephropathy and renal scarring, with consequent loss of renal parenchyma.

However, VUR is an extremely complex entity, whose diagnosis, management and timing of treatment remain a challenge.
There is a clear co-prevalence between lower urinary tract dysfunction (LUTD) and VUR, meaning the presence of low urinary tract symptoms, such as urge, incontinence, hesitancy, frequency and urinary tract infections (UTI).
Some recommendations for screening VUR are the presence of recurrent UTI, UTI with renal ultrasound changes, isolated changes in the urinary system and selected cases of prenatal...

...read more

Figure 1. A. Exam room – a friendly environment is essential to infant’s colaboration (video and cartoon projection on the walls). B. Material for the technique. © Radiology Department, Centro Hospitalar Universitário do Algarve/Portugal 2022
Figure 2: Illustration of VUR grading system using ceVUS. Dual imaging with conventional B-mode (A, D, G, J) and imaging harmonic mode (B, C, E, F, H, I, K, L). VUR diagnosis is defined by the presence of echogenic microbubbles (from the contrast agent) in the upper urinary tract – pelvis and calyces (B, E, H, K) and ureter (C, F, I, L). © Radiology Department, Centro Hospitalar Universitário do Algarve/Portugal 2022
Conclusions

ceVUS is a safe, radiation-free technique, with a comparable sensitivity to CVUS to diagnose VUS in young children, also allowing the evaluation of other urological pathologies.

The technical execution is quite accessible, depending of a well-organized team of professionals, compatible sonographic software and availability of ultrasound contrast, allowing its universal usage. It is expected that, in the future, this becomes the main diagnostic tool of nephropathology in the pediatric age.