The role of contrast-enhanced voiding urosonography in the evaluation of vesicoureteral reflux in children
Number:28ESURABS0120
Type:Educational Electronic Presentation
Authors: Carmelo Sofia, Antonino Cattafi, Francesco Marcello Arico', Nicola Migliaccio, Maria Adele Marino, Giorgio Ascenti
Keywords:Contrast-Enhanced Voiding Urosonography, ceVUS, Vesicoureteral reflux, pediatrics
SECTIONS
Educational objective

To show the role of contrast-enhancement voiding ultrasound (ceVUS) in the diagnosis and staging of vesicoureteral reflux (VUR) in children.

Topic Review

BACKGROUND

Vescicoureteral reflux (VUR), defined as the retrograde flow of urine from the bladder back up the ureter into the kidney, is present in 10% to 40% of children with a urinary tract infection and is associated with a higher risk of nephro-vascular hypertension and renal scarring with Chronic kidney Disease (CKD). In some cases, bladder ureteral reflux is associated with the presence of Congenital Anomalies of Kidneys and Urinary Tracts (CAKUT). RVU can be primary or secondary. Primary RVU is caused by the presence of a short portion of submucosal ureter within the bladder. Secondary RVU develops when there is high intravesical pressure that causes retrograde flow of urine and is associated with posterior urethral valves, urethral obstruction or a neurogenic bladder. Imaging plays a central role in the diagnosis of RVU. Its main objectives...

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Video 1. The video shows a left grade 3 VUR.
Table 1. Scheme of vesicoureteral reflux grading in contrast-enhanced VUS. Modified from Darge et al (Pediatric Radiology 2008)
Conclusions

CeVUS represents an effective method for the assessment of vesicoureteral reflux in children , except in cases of complex malformations in which voiding cystourethrography (VCUG) should be still considered the gold standard method.