The value of ultrasound evaluation in predicting high-grade vesicoureteral reflux in children under two years of age
Authors:
Oldřich Šmakal 1; Jan Šarapatka 1; Jan Vrána 1; Hana Flögelová 2; Tereza Kleštincová 2
Authors‘ workplace:
Urologická klinika, LF UP a FN Olomouc
1; Dětská klinika, LF UP a FN Olomouc
2
Published in:
Ces Urol 2018; 22(1): 32-39
Category:
Original Articles
Overview
The main aspect of the paper:
A prospective study evaluated the benefit of ultrasound evaluation in predicting grade IV–V vesicoureteral reflux in children aged 0–2 years investigated for asymptomatic upper urinary tract dilation detected on ultrasound screening or after having had acute pyelonephritis.
Aim:
To assess the value of ultrasound evaluation in predicting grade IV–V vesicoureteral reflux in children aged 0–2 years investigated for postnatal detection of upper urinary tract dilation or after having had acute pyelonephritis.
Method:
In a prospective study, the measured ultrasound parameters of the upper urinary tract (anteroposterior renal pelvis diameter, parenchymal thickness, and ureteral width) were compared with the results of voiding cystourethrography in two cohorts of patients aged 0−2 years. Patient cohort 1 was investigated for postnatal detection of upper urinary tract dilation, while patient cohort 2 included those who had had acute pyelonephritis. Fisher’s test at the 5% significance level, chisquare test, and logistic regression test were used for statistical analysis.
Results:
Voiding cystourethrography was performed in 101 children in patient cohort 1. Grade IV–V vesicoureteral reflux was shown in 22 children (21.8%) – 5 girls (23%) and 17 boys (77%). The mean age at which a VCUG was performed in this patient cohort was 3.95 months, with a median of 3 months (1–22). A ureter ≥3 mm was found in 12 children (55%) and a renal pelvis ≥5 mm in 21 children (95%). The statistical analysis failed to find a statistically significant association between the observed ultrasound parameters and evidence of grade IV–V vesicoureteral reflux.
In patient cohort 2, voiding cystourethrography was carried out in 84 children. Grade IV–V vesicoureteral reflux was found in 24 children (28.6%) – 11 girls (46%), 13 boys (54%). The mean age at which a VCUG demonstrating high-grade vesicoureteral reflux was performed was 6.55 months, with a median of 4.5 months (1–17). A ureter ≥3 mm was detected in 9 children (41%) and a renal pelvis ≥5 mm in 19 children (86%). The statistical analysis demonstrated a significant association between a transverse diameter of the renal pelvis ≥5 mm in 19 children (86%). The statistical analysis demonstrated a significant association between a transverse diameter of the renal pelvis <8 mm and evidence of grade IV–V vesicoureteral reflux (p = 0.037) as well as between a parenchymal thickness <8 mm and evidence of grade IV–V vesicoureteral reflux (p = 0.019).
Conclusion:
In patients aged 0–2 years with ultrasound screening evidence of upper urinary tract dilation, ultrasound evaluation of renal pelvis and ureteral diameter or of parenchymal thickness fails to predict high-grade vesicoureteral reflux. In patients aged 0–2 years who had acute pyelonephritis, transverse diameter of the renal pelvis below 8 mm and/or parenchymal reduction of less than 8 mm are indicative of the presence of grade IV–V vesicoureteral reflux.
Key words:
Children, voiding cystourethrography, ultrasound, vesicoureteral reflux.
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Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2018 Issue 1
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