A comparison of echo-enhanced voiding urosonography with X-ray voiding cystourethrography in the first year of life

Background: Second-generation echo-enhanced voiding urosonography (VUS) with improved contrast-specific ultrasound (US) techniques is increasingly being used for vesicoureteric reflux (VUR) detection. Aim: To compare VUS with X-ray voiding cystourethrography (VCUG) and to evaluate the predictive value of pelvicalyceal dilatation for detecting VUR in the first year of life. Materials and methods: Sixty-six children younger than one were investigated by US, VUS and VCUG. VCUG represented the reference method for VUR detection. Results: According to VCUG, VUR was present in 16/132 (12%) renal units. VUS confirmed all these and additionally revealed VUR in 26 renal units (all together 42/132 (32%) renal units with VUR). It should be noted that all VUR detected only with VUS and missed by VCUG were of grades II and III. In 27/92 (29%) US normal and in 15/40 (37%) renal units with pelvicalyceal dilatation, VUR was detected by VUS. Conclusion: We believe that VUS could safely replace VCUG in VUR detection in infants, with no regard to the degree of abnormality of the upper urinary tract seen on US. VCUG should be limited only to cases where bladder and/or urethra pathology are suspected.