211 VESICOURETERAL REFLUX IS NOT RELIABLY DETECTED WITH RENAL ULTRASOUND

Abstract

Nowadays, clinicians rely greatly on Renal Ultrasound (RU) as a screening examination. RU seems to be less sensitive than Fluoroscopic Voiding Cystourethrography (FVCU) for the detection of Vesicoureteral Reflux (VUR), but relevant percentages in large numbers of patients with Urinary Tract Infection (UTI) are scanty. This study evaluates the potential reliability of RU as a means to detect VUR in children with UTI. The population under study consisted of 288 infants and children (101 boys and 187 girls, median age 3.8 years) with UTI. RU and FVCU were performed within the same day. For data analysis both kidneys were considered separately for a total of 576 kidneys. Of 576 kidneys, VUR documented on FVCU in 116 (20%). In 85 of these refluxing kidneys (73%), the RU was normal and in 31 (27%) was abnormal. Of 517 normal kidneys on RU 85 (16%) had VUR on FVCU. In the remaining 59 kidneys with an abnormal RU (dublex system, dilatation, pyelonephritis, small scarred kidney), VUR was documented on FVCU in 31 (53%). This study oonfirms, that RU does not reliably diagnose VUR, since only 27% of the refluxing kidneys were identified on RU. On the other hand, patients with an abnormal RU would alert the clinician and radiologist to the increased possibility of VUR (53%). It is concluded, that a) RU is not an adequate substitute for the FVCU, if the clinical question is VUR in children with UTI, b)RU should be performed prior to FVCU.