Application of contrast-enhanced ultrasound in the surgical treatment of vesicoureteral reflux in children

Abstract

Background: To determine the utility of contrast-enhanced voiding urography (CeVUS) in the treatment of vesicoureteral reflux (VUR) through ureterovesical reimplantation in children.

Methods: A total of 159 children with recurrent urinary tract infections were selected for CeVUS and voiding cystourethrography (VCUG) from December 2018 to December 2020, among whom 78 patients were eventually diagnosed with VUR. Overall, 60 pyelo-ureteric units (PUUs) were operated according to surgical indications. Accordingly, we determined the general clinical characteristics of all children, obtained two-dimensional ultrasound images, assessed the reflux status of children using the contrast-enhanced technique, and compared the obtained results via CeVUS and VCUG. Both imaging modalities were reperformed at 6, 12, and 18 months after surgery to evaluate postoperative outcomes. In particular, we assessed the consistency of the evaluation and calculated the diagnostic efficacy of CeVUS for different levels of reflux at different time points.

Results: CeVUS showed considerable efficacy in the diagnosis of children with VUR. Notably, the diagnostic results of both CeVUS and VCUG achieved high agreement, with a kappa value of 0.966 (P < 0.001). The results of our follow-up at different stages and evaluation of postoperative efficacy revealed that CeVUS possessed substantial diagnostic efficacy and good consistency with VCUG.

Conclusion: CeVUS is an accurate and safe examination, with considerable clinical significance for diagnosing VUR in children, determining the treatment approach, conducting follow-up during treatment, and evaluating subsequent treatment outcomes.

Keywords: Contrast-enhanced voiding urosonography; Ureterovesical reimplantation; Vesicoureteral reflux.

Fig. 1

Ultrasound angiogram of vesicoureteral reflux. (Upper left: diagram of a grade I left cystoureteral reflux; upper middle: diagram of a grade II right cystoureteral reflux; upper right: diagram of a grade III right cystoureteral reflux; lower left: diagram of a grade IV right cystoureteral reflux; lower middle: diagram of a grade V left cystoureteral reflux; lower right: comparison diagram of a grade V left cystoureteral reflux detected using contrast-enhanced voiding urography and voiding cystourethrography)