Fluoroscopic Voiding Cystourethrography and Voiding Vesicoureteral Ursonography as A Comparison in Pediatric Vesicoureteral Reflux

Abstract

Background: Vesicoureteral reflux (VUR) is a significant pediatric condition linked to recurrent urinary tract infections (UTIs) and can adversely affect a child's growth and development if not diagnosed promptly. Traditional diagnostic methods such as fluoroscopic voiding cystourethrography (VCUG) offer high accuracy but involve radiation risks, which are particularly concerning in pediatric populations. Objective: To compare the efficacy and safety of voiding vesicoureteral urosonography (VUS) with VCUG in the diagnosis of VUR in children, highlighting the advantages of a radiation-free method. Methods: This cross-sectional study included 208 renal ureteral units from 145 children diagnosed with VUR at the University of Lahore Teaching Hospital between July 2022 and September 2023. Patients underwent both VCUG and VUS. VUS utilized a SonoVue contrast agent, and the imaging involved real-time monitoring using a Super Sonic Imagine's Aixplorer V model with CEUS+ capability. Data were analyzed using SPSS version 25, focusing on the agreement between VUS and VCUG in diagnosing various grades of VUR. Results: VUS accurately identified no reflux in 98 of 112 cases as confirmed by VCUG. In higher grades of reflux (III to V), VUS detected 24 of 32 cases for Grade III, 7 of 13 for Grade IV, and 10 of 13 for Grade V. The overall agreement analysis revealed substantial consistency between VUS and VCUG across all grades of VUR, demonstrating that VUS can effectively identify higher grades of reflux. Conclusion: Voiding vesicoureteral urosonography is a viable and safer alternative to VCUG for the diagnosis of VUR in pediatric patients. It offers the benefits of being radiation-free, with high diagnostic accuracy, particularly in detecting severe cases of reflux. This study supports the increased adoption of VUS in clinical settings, especially for children, to reduce radiation exposure risks.