Voiding urosonography: the study of the urethra is no longer a limitation of the technique

Abstract

Background: Voiding urosonography (VUS) has proved to be a reliable method for the study of vesicoureteric reflux (VUR). Early reports considered it inadequate for imaging the male urethra.

Objective: To determine the usefulness of contrast-enhanced VUS for the study of the urethra.

Material and methods: A total of 208 children aged 2 days to 10 years underwent VUS to confirm or exclude VUR for different reasons (n = 150) or for follow-up (n = 58). Patients with unconfirmed suspicion of VUR (99 boys and 51 girls) also underwent VUS for the study of the urethra. Examinations were performed using a harmonic imaging mode specific for contrast (Levovist) enhancement. We used a 6-4-MHz convex probe and a transperineal and/or a transpelvic approach.

Results: The neck of the bladder and the entire urethra were visualized in all patients (n = 150). The male urethra was considered normal in 95 boys (95.95%). We diagnosed posterior urethral valves in two patients, diverticulum of the prostatic utricle in one, and diverticulum of the anterior urethra in one. All abnormal cases were confirmed using conventional voiding cystourethrography.

Conclusion: VUS can replace voiding cystourethrography as the method of choice for the initial study of suspected VUR in children.