The Role of Contrast Enhanced Voiding Urosonography in Evaluation of Pediatric Urinary Tract Infection and Antenatal Hydronephrosis

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Introduction: 30-50% of children presenting with urinary tract infection (UTI) as well as 8-38% of children diagnosed with antenatal hydronephrosis (ANH) have vesicoureteric reflux (VUR). The standard technique for the diagnosis of VUR is voiding urethrocystrogaphy (VCUG); however, it is associated with ionizing radiation. Contrast-enhanced voiding ultrasonography (ceVUS) is an alternative, radiation-free method with sensitivity and specificity in the diagnosis of VUR comparable with VCUG respectively, and with the ability to depict the structure of the urethra. Aim: The aim of this article is to present our experience with ceVUS and to discuss its clinical indications in the context of the actual guidelines for the management of UTI in children and ANH. Material and Methods: 118 ceVUS studies (236 nephroureteral units) performed in the period October 2016 to December 2017 were reviewed. 67 of patients were females and 51 males; the median age was 3.2 years, range: 1 month-18 years. Results: VUR was shown in 62 (52.5%) children in 97 (41%) nephroureteral units. The urethra was shown in 90 (76%) children without significant pathology, except spinning top urethra found in 9 girls. Adverse events related to the examination were not reported, except one iatrogenic UTI. Conclusion: In imaging of children presenting with UTI and ANH, ceVUS is an important radiation-free method for detection of VUR and evaluation of urethra. It is an acceptable alternative for radiation-associated VCUG in most clinical instances and should be incorporated into the imaging protocols of pediatric UTI and ANH.