Técnicas de imagen en el reflujo vesicoureteral

Abstract

Although vesicoureteral reflux (VUR) is a very frequent pathology in the pediatric age and represents an important part of the activity of pediatricians, pediatric urologists, nephrologists, and radiologists, yet there is controversy about its global management both in diagnosis and treatment. The objective of this paper is to perform an update in the use of different imaging techniques in the diagnosis and followup of VUR and to propose a work up protocol. We describe the imaging techniques: VCUG, ultrasound, intravenous urography, bladder-ultrasound, DMSA, MRI, and their role in the evaluation and followup of VUR. We performed a bibliographic review about the topic and present the experience of our working group on VUR. The bibliographic review shows a clear evolution of the concepts of VUR and also the management algorithms. The concepts of congenital renal lesion without urinary tract infection (UTI) or acquired lesion after UTI are clearly differentiated in the most recent reviews. Reflux is passing from being the center of the problem to a secondary phenomenon in relation to UTI, and this is leading to a change of diagnostic strategy, less and less invasive. VCUG has been to date the first and indisputable technique for the management of VUR, mainly in the diagnostic phase, but technological advances in the area of ultrasound (ultrasound contrasts, harmonic image, etc.) have converted ultrasound in the first imaging technique for the management of VUR in pediatric age. On the other hand, work-up algorithms have changed due to the great impact prenatal diagnosis is having in the management of urinary tract anomalies.