腹腔镜Lich-Gregoir手术治疗儿童双侧原发性膀胱输尿管反流

目的 评价腹腔镜Lich-Gregoir手术治疗儿童双侧原发性膀胱输尿管反流治疗效果.方法 对2007年9月至2009年9月4例腹腔镜Lich-Gregoir手术治疗双侧原发性膀胱输尿管反流患儿的临床资料进行回顾性分析.结果 4例患儿,均因反复尿路感染收治.平均年龄6.5岁(5～8岁).男1例,女3例,排尿行膀胱尿道造影(VCUG)均提示双侧VUR,其中Ⅴ级2侧,Ⅳ级3侧,Ⅲ级3侧.二巯丁二酸(DMSA)肾图均证实存在一侧或双侧肾瘢痕.所有病例均经腹腔路径成功于膀胱外完成腹腔镜Lich-Gregoir手术.平均手术时间为200min(140～300min),术中无明显出血,术后平均住院时间6 d(5～7 d).平均随访18.5个月(6～30个月),所有患儿术后6个月VCUG复查证实膀胱输尿管反流均完全消失,无发热性尿路感染及新的肾瘢痕形成.1例患儿术后出现短期尿潴留,留置导尿1周后症状消失.结论 我们的初步经验显示腹腔镜Lich-Gregoir手术安全、有效、创伤小、术后恢复快,有望成为治疗儿童原发性膀胱输尿管反流,尤其是双侧病变较理想的治疗方法.     

腹腔镜下膀胱外输尿管膀胱再植术治疗儿童输尿管膀胱连接部异常21例报告

目的 探讨腹腔镜下膀胱外输尿管膀胱再植术治疗儿童输尿管膀胱连接部异常的临床疗效.方法 回顾性分析我院2014年10月至2016年1月用腹腔镜膀胱外输尿管膀胱再植术治疗21例输尿管膀胱连接部异常患儿的临床资料.其中输尿管膀胱连接部狭窄14例,输尿管膀胱连接部反流3例,输尿管异位开口4例.术前检查包括泌尿系统超声检查、泌尿系统CT三维重建成像检查、排泄性膀胱尿道造影和肾图检查.所有患儿术前检查均提示输尿管全程扩张,有反复尿路感染史14例,伴发肾积水9例,输尿管全程扩张达20 mm以上者6例,术前肾图结果提示异常者10例.结果 21例均经腹腔镜完成手术,无中转开放.手术时间120～170 min.术后4例出现轻度肉眼血尿,1d后消失.术后平均住院时间为8d,所有患儿术后无尿潴留发生,无吻合口漏发生.术后随访3～12个月,有2例发生尿路感染(9.5％),1例予口服抗生素及多饮水后缓解,1例抗感染治疗无效后,膀胱镜下取出双J管后缓解.术前肾图11例正常,10例患侧异常,术后3个月异常者有8例复查肾图,较术前有改善,失访2例.术后3～6个月超声复查输尿管直径均小于6mm.结论 腹腔镜下膀胱外输尿管膀胱再植术治疗儿童输尿管膀胱连接部异常疾病安全有效,术中用时合理、出血少,膀胱创伤小,肾功能有明显改善,临床疗效确切,且具有微创优势.     

机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流

目的探讨机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流的可行性、安全性和手术技巧。方法回顾性分析2014年5月至2019年2月上海市儿童医院收治的11例原发性膀胱输尿管反流患儿临床资料,其中男童10例,女童1例,均应用达芬奇系统辅助腹腔镜行Lich-Greqoir输尿管再植手术。患儿平均年龄9.4岁(3.2~18岁)。其中双侧4例,单侧7例。反流程度Ⅱ~Ⅳ级(Ⅱ级2侧,Ⅲ级3侧,Ⅳ级10侧)。结果患儿均采用Lich-Gregoir术式,术中患侧输尿管平均直径9 mm(5~15 mm),平均黏膜下隧道长度4.4 cm(3~6 cm)。术中无中转开放手术,单侧输尿管手术平均时间152 min(132~175 min),双侧输尿管手术平均时间257 min(249~264 min),术后平均住院时间4.5 d(3~6 d),1例双侧VUR患儿术后出现短期尿潴留,延长留置导尿管2周后痊愈。患儿平均随访时间2.5年(6个月至5.3年),所有病例均无发热性尿路感染,B超均未见患侧输尿管肾盂积水加重。术后完成VCUG 9例(其中双侧4例,单侧5例),其中1例双侧病例术后发现左侧反流Ⅰ级。结论机器人辅助腹腔镜下Lich-Greqoir手术治疗儿童原发性膀胱输尿管反流安全、有效,可以应用于3岁以上儿童的治疗。     

尿路感染与原发性膀胱输尿管反流

目的 了解儿童尿路感染中原发性膀胱输尿管反流的发生情况。方法 62例尿路感染患儿行排泄性膀胱尿路造影，诊断原发性膀胱输尿管反流并分级，以做相应治疗。结果 膀胱输尿管反流在尿路感染住院患儿中比例为40.32％。结论 儿童尿路感染的住院患儿，尤其反复发作者，存在原发性膀胱输尿管反流比例较大。     

神经性膀胱输尿管反流治疗对策的探讨

目的探讨神经性膀胱患儿输尿管反流的治疗措施。方法脊膜修补术后神经性膀胱并输尿管反流患儿45例,男29例,女16例,年龄4～14岁。排泄性膀胱尿道造影(VCUG)示膀胱输尿管反流左侧19例,右侧11例．双侧15例,其中Ⅰ°-Ⅲ°12例(15条),Ⅲ°-Ⅴ°33例(45条)。Ⅰ°-Ⅱ°中,5例(7条)仅行清洁间歇导尿,7例(8条)行保留膀胱黏膜肠浆肌层膀胱扩大术；Ⅲ°-Ⅴ°中,9例(12条)仅行间歇导尿。24例(33条)行保留膀胱黏膜肠浆肌层膀胱扩大术,其中19例(28条)同时行Lich-Gregoir手术,术后配合间歇导尿。结果6个月后随访,Ⅰ°-Ⅱ°15条中,7条行清洁间歇导尿,3条反流消失(42．9%),8条行保留膀胱黏膜肠浆肌层膀胱扩大术者,6条反流减轻或消失(75．0%)；Ⅲ°-Ⅴ°45条中,12条行间歇导尿者,10条反流程度进一步加重,5条单纯行膀胱扩大术者,2条反流减轻或消失(40．0%),28条同时行Lich-Gregoir手术者,23条反流减轻或消失(82．1%)。结论神经性膀胱输尿管反流的治疗方法取决于输尿管反流的程度。Ⅰ°-Ⅱ°单纯行膀胱扩大术,也可考虑只行清洁间歇导尿；Ⅲ°-Ⅴ°反流须在行膀胱扩大术的同时行输尿管抗反流术,术后配合间歇导尿。     

神经性膀胱的评价和治疗

目的评价不同严重程度神经性膀胱患儿的治疗方法和结果。方法 2013年4月至2014年1月我们收治神经性膀胱患儿15例,男7例,女8例,年龄1~13岁,均有脊膜膨出修补术病史。全部患儿行尿动力学检查、泌尿系超声和排泄性膀胱尿道造影。尿动力学检查显示9例合并逼尿肌压升高,12例合并膀胱容量减少,7例合并逼尿肌过度活动;泌尿系超声和排泄性膀胱尿道造影显示8例合并肾积水和输尿管扩张,7例合并输尿管反流。5例行手术治疗,其中1例行小肠膀胱扩大及输尿管抗反流术,2例行逼尿肌部分切除膀胱扩大术及输尿管抗反流术,1例行小肠膀胱扩大术,1例行输尿管抗反流术,术后配合清洁间歇导尿。其余10例行清洁间歇导尿,4例同时口服索利那新。结果2例小肠膀胱扩大术后膀胱容量明显增加,逼尿肌压明显下降,输尿管反流消失;2例逼尿肌部分切除膀胱扩大术者膀胱容量略有增加,逼尿肌压略有下降,仍存在输尿管反流。1例输尿管抗反流者反流消失。保守治疗患儿中,膀胱容量在正常容量的2/3以上且逼尿肌压较低的6例患儿中,2例尿失禁消失,2例失禁较前明显减轻,2例无改善;膀胱容量不足正常1/2,逼尿肌压较高的4例患儿中,尿失禁及输尿管反流无明显减轻;4例应用索立那新后逼尿肌过度活动明显减轻。结论尿动力学检查泌尿系超声和排泄性膀胱尿道造影是评价神经性膀胱的重要手段,神经性膀胱患儿要根据其评价结果采取个性化的治疗方案。     

改良Lich-Gregoir手术治疗神经性膀胱输尿管反流的评价

目的　探讨改良Lich Gregoir手术在治疗神经性膀胱输尿管反流中的应用。方法　神经性膀胱并输尿管反流患儿 12例 ,男 8例 ,女 4例 ,年龄 4～ 14岁 ,均为脊膜膨出修补术后。排泄性膀胱尿道造影 (VCUG)示膀胱输尿管反流左侧 5例 ,右侧 3例 ,双侧 4例 ,其中Ⅲ° 4条 ,Ⅳ° 10条 ,Ⅴ°2条。全部行改良Lich Gregoir输尿管抗反流术 ,同时行保留膀胱黏膜肠浆肌层膀胱扩大术。结果　术后 6个月随访 ,VCUG显示 16条反流的输尿管中 ,Ⅲ° 4条反流完全消失 ,Ⅳ°10条中 3条变为Ⅰ°,3条变为Ⅱ° ,1条变为Ⅲ°,3条无明显变化 ,Ⅴ°2条变为Ⅲ°。结论　神经性膀胱逼尿肌压增高 ,导致膀胱输尿管连接部功能失调 ,同时逼尿肌纤维化、膀胱挛缩 ,使得输尿管膀胱壁内段缩短 ,是输尿管反流的重要原因。行改良Lich Gregoir输尿管抗反流术的同时 ,须行膀胱扩大术 ,降低逼尿肌压 ,增加膀胱顺应性。     

腹腔镜Lich-Gregoir术与开放Cohen术治疗儿童原发性膀胱输尿管反流的疗效分析

目的探讨腹腔镜Lich-Gregoir术与开放Cohen术在儿童原发性膀胱输尿管反流(vesicoureteral reflux, VUR)治疗中的应用价值。方法本研究为回顾性研究, 将2018年6月至2022年6月首都医科大学附属北京儿童医院接受手术治疗的150例原发性VUR且资料完整的患儿纳入研究。按照手术方式的不同分为腹腔镜Lich-Gregoir组(n=69)和开放Cohen组(n=81);根据VUR侧别的不同以及术中是否行输尿管裁剪, 将腹腔镜Lich-Gregoir组进一步分为单侧未裁剪输尿管腹腔镜Lich-Gregoir组(A组, n=33)、双侧未裁剪输尿管腹腔镜Lich-Gregoir组(C组, n=16)、单侧裁剪输尿管腹腔镜Lich-Gregoir组(E组, n=12)、双侧裁剪一侧输尿管腹腔镜Lich-Gregoir组(G组, n=8), 开放Cohen组进一步分为单侧未裁剪输尿管开放Cohen组(B组, n=30)、双侧未裁剪输尿管开放Cohen组(D组, n=20)、单侧裁剪输尿管开放Cohen组(F组, n=18)、双侧裁剪一侧输尿管开放Cohen组(H组...     

婴幼儿发热性尿路感染的影像学检查评价

目的 探讨肾脏超声检查(US)、放射性核素肾静态扫描(DMSA)和排泄性膀胱尿道造影(VCUG)检查在婴幼儿发热性尿路感染(UTI)中的应用价值.方法 发热性UTI患儿人院1周内进行US及DMSA检查,2周后进行VCUG检查,急性期DMSA异常者6个月复查,并对US、DMSA和VCUG检查结果进行回顾性分析.结果 婴幼儿发热性UTI患儿160例,急性期接受US、DMSA和VCUG三项检查的共75例,VCUG检出VUR患儿23例(35个VUR肾输尿管单位),检出率为30.7%;35个VUR肾输尿管单位中,Ⅰ级反流0个,Ⅱ级8个(22.9%).Ⅲ级11个(31.4%),Ⅳ级14个(40.0%),V级2个(5.7%).35个反流肾输尿管单位中,US提示反流的有15个;无反流的114个肾输尿管单位中US提示反流的有12个,US筛查VUR的敏感性为42.9%,特异性为89.5%,阳性预测率为55.6%,阴性预测率为83.6%.35个反流的肾输尿管单位中,DMSA提示异常的有31个;无反流的114个肾输尿管单位中,DMSA提示异常的有61个,DMSA筛查VUR的敏感性为88.6%,特异性为46.5%,阳性预测率为33.7%,阴性预测率为93.0%.24例6个月后DMSA复查发现肾瘢痕形成15例,占62.5%,其中VUR患儿有10例,反流程度均为Ⅲ级或Ⅲ级以上.结论 发热性UTI婴幼儿中VUR的发生率高,以严重VUR多见,且容易形成肾瘢痕,US、VCUG和DMSA均应作为常规评估检查.     

膀胱自体扩大术在神经性膀胱患儿中的应用评价

目的评价逼尿肌部分切除、膀胱自体扩大术的临床疗效。方法选择脊髓脊膜膨出患儿6例,其中男性3例,女性3例,年龄18个月至9岁。患儿均口服索利那新和行清洁间歇导尿3个月后无好转而行逼尿肌部分切除、膀胱自体扩大术,术后予清洁间歇导尿,手术前及术后1年行泌尿系超声、排泄性膀胱尿道造影,并行尿动力评价,评价指标为膀胱容量、膀胱顺应性和充盈末逼尿肌压。结果术前尿动力学检查显示6例患儿膀胱容量减小、膀胱顺应性下降及逼尿肌压升高,其中5例膀胱容量低于预期容量的50%。排泄性膀胱造影4例合并膀胱输尿管反流,其中左、右侧Ⅳ°反流各1例,双侧Ⅳ°反流2例。6例患儿手术后恢复顺利,无穿孔、感染发生。术后1年尿动力学检查显示6例患儿膀胱容量略有增加,但膀胱容量与预期膀胱容量(年龄×30+30)、膀胱顺应性及逼尿肌压力无明显变化,VCUG显示4例输尿管反流无减轻。结论对于膀胱容量明显变小的神经性膀胱患儿,逼尿肌部分切除、膀胱扩大术不能有效增加膀胱容量和顺应性,降低逼尿肌压,临床不能取得满意的效果。     

降钙素原对尿路感染儿童膀胱输尿管反流的诊断价值及其关联性

目的 探讨降钙素原（PCT）对儿童尿路感染伴膀胱输尿管反流（VUR）的诊断价值及其关联。 方法 纳入2012年1月1日至2015年12月31日湖南省儿童医院首次诊断为尿路感染且住院期间进行了PCT、CRP检测、排尿期膀胱尿道造影（VCUG）检查和尿液细菌定量培养的患儿,排除医院获得性尿路感染者和进行过尿道外科手术者。以VCUG作为金标准,以PCT和CRP为待测标准,将诊断为VUR的患儿分为无反流组和反流组（轻度反流亚组和重度反流亚组）。采集性别、月龄和VCUG信息,仅截取入院后24 h内行PCT和CRP检测的结果。比较PCT和CRP对VUR的诊断参数。 结果 进入本文分析的尿路感染患儿156例,经VCUG确诊的VUR （反流组）58例,其中轻度反流亚组38例,重度反流亚组20例;无反流组98例。无反流组与反流组患儿月龄、男女比例差异无统计学意义（Z=-1.667, P=0.096;χ2=0.291,P=0.590）。PCT(ng·mL-1)和CRP(mg·L-1)反流组高于无反流组［1.01（0.78,1.28）vs 0.40（0.10,0.60）和14.2（8.9,31.1）vs 11.0（6.6,19.5）］,差异有统计学意义（Z=-7.863, P=0.000;Z=-2.327, P=0.02）。PCT无反流组与轻度反流亚组［0.99（0.68,1.16）］和重度反流亚组［1.57（0.93,1.96）］、CRP无反流组与重度反流亚组［28.9（12.7,45.2）］、PCT与CRP轻度反流亚组及重度反流亚组,差异均有统计学意义。CRP无反流组与轻度反流亚组［12.6（8.5,19.5）］,差异无统计学意义。PCT区分有无反流的最佳截值为0.77 ng·mL-1,敏感度为77.6%,特异度90.8%,ROC曲线下面积0.877（95％CI：0.811~0.943）。在控制了性别和CRP等因素的情况下,PCT≥0.77 ng·mL-1的尿路感染患儿VUR的风险是PCT＜0.77 ng·mL-1的3.604倍。 结论 PCT对于判断尿路感染患儿是否存在VUR具有一定的临床价值,可作为预测VUR的独立指标。     

Detection of low-grade vesicoureteral reflux in children by color Doppler imaging mode

Vesicoureteral reflux (VUR) is common in children with urinary tract infections (UTI) and may result in renal scarring or reflux nephropathy. To date, the primary diagnostic tool has been voiding cystourethrography (VCUG). A new technique for evaluation of grade 1 and 2 VUR is described using color Doppler imaging-mode cystography (CDIMC): 77 children, aged 7 months to 14 years, were examined for VUR by CDIMC and standard VCUG. According to the established reflux sonography (US) using a real-time mode, all patients selected for this study had a normal urinary tract on conventional gray-scale US. We studied 154 ureters, and a total of 31 were found to be refluxing on CDIMC and 30 on VCUG. A positive sonogram was defined as visualization of Doppler signals from the bladder to the ureter during the course of bladder filling. Taking VCUG as the gold standard, we had ten false-positive findings. The false-positive rate of 18.5% may have been due to the shorter observation time of fluoroscopy. Comparison of the two methods shows CDIMC to be 70% sensitive with a specificity of 92% in the detection of VUR grade 1 and 2. To evaluate the incidence of asymptomatic low-grade VUR in a non-infected population, a second series of 38 children (19 males, 19 females) aged 3 to 15 years (mean 8.8 years) with normal urologic status and urine cultures were studied by color Doppler imaging mode (CDIM) for detection of asymptomatic low-grade VUR. Four children were found to have a unilateral refluxing ureter. The incidence of VUR in children with a normal urinary tract and no prior UTI was 10.5%. In conclusion, CDIMC can be used as a possible alternative to standard VCUG for the screening and follow-up of low-grade VUR. In addition, our study indicates that asymptomatic grade 1 and 2 reflux might be a physiological condition.     

Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux

BACKGROUND: Fluoroscopic voiding cystourethrography (VCUG) is a widely used imaging test for the diagnosis of vesicoureteral reflux (VUR). However, high gonadal radiation and intermittent imaging are the main disadvantages of VCUG. Direct radionuclide cystography (DRC) has been advocated for the detection of VUR with increased sensitivity and low radiation doses, however, having the disadvantage of providing less anatomical details for urethral evaluation. In this study, DRC has been compared with standard fluoroscopic VCUG for detection of VUR. METHODS: A total of 41 children (82 kidney ureter units, KUU) aged 1 month-126 months (median, 15 months) were studied sequentially using DRC and VCUG. The indications of VUR studied were urinary tract infection in 29 children, VUR follow up in eight children and antenatal dilatation history in four children. RESULTS: A total of 18 refluxing ureters were detected by DRC, 22 refluxing ureters by VCUG and 14 refluxing ureters by both methods. The two methods were concordant for the detection and exclusion of VUR in 85% of KUU. VUR was missed by VCUG in four KUU (three severe, one mild) whereas VUR was missed by DRC in eight KUU (four grade I, four grade III). CONCLUSIONS: There was a good correlation between DRC and VCUG in the evaluation of VUR. DRC provides continuous monitoring and low gonadal radiation exposure. DRC can be used in the diagnosis of VUR as an alternative to VCUG in selected cases.     

Voiding urosonography as first step in the diagnosis of vesicoureteral reflux in children: a clinical experience

Background Contrast-enhanced voiding urosonography (VUS) is becoming more widely used for the diagnosis of vesicoureteric reflux (VUR), but until now its use has only been accepted for first diagnosis in females and in the follow-up of children, including boys, who have already undergone voiding cystourethrography (VCUG). Objective To describe our 6-year experience with VUS used as a first step in the diagnosis of VUR. Materials and methods A total of 610 children (334 boys, 276 girls; mean age 22 months), underwent VUS as the first step in the diagnosis of VUR. In selected children, VCUG was also performed. Results VUR was detected in 199 of 610 VUS examinations, and 265 refluxing kidney–ureter units were found. Children with VUR underwent antibiotic prophylaxis or surgery. Children without VUR underwent clinical follow-up. Just 60 children underwent VCUG. The criteria for VCUG were: high-grade VUR after consultation with a urologist, onset of urinary tract infection while receiving prophylaxis, nondiagnostic VUS, and other malformations with or without clinical signs. Conclusion Our experience suggests that we can use VUS as the first step in the diagnosis of VUR in children, boys and girls, with a significant reduction in radiation exposure.     

小儿遗尿与膀胱输尿管反流的相关性研究

目的 探讨小儿遗尿与膀胱输尿管反流(vesicoureteral reflux,VUR)的关系,筛选小儿VUR的高危因素为临床诊治提供依据.方法 选取郑州大学第一附属医院小儿尿动力学中心以遗尿为主诉就诊并且神经功能正常的儿童和青少年83例(男36例,女47例),年龄5～16岁,平均(9.42±3.21)岁.所有患儿进行排尿性膀胱尿道造影(VCUG)检查以评估VUR情况,并进行尿常规、尿培养、肾脏和膀胱超声检查.尿动力学检查包括尿流率、盆地肌电图和膀胱压力容积测定.泌尿系检查的准入标准包括泌尿系超声异常、白天尿失禁、尿动力学检查异常、尿路感染或者同胞兄妹中有VUR病史等.结果 48例(57.8％)出现单症状性夜遗尿(MNE),35例(42.2％)非单症状性夜遗尿(NMNE).13例(15.7％)出现VUR.t检验结果显示,白天尿失禁患儿、女性患儿和当前伴有尿路感染的患儿VUR发病率明显升高(P＜0.05);多自变量logistic回归分析结果显示,只有性别、白天尿失禁和当前尿尿路感染的回归系数检验有统计学意义(P＜0.05),VUR与患儿年龄、遗尿类型(原发性、继发性)、遗尿频率、有无遗尿家族史、尿路感染病史、有无排便异常和除白天尿失禁外的白天尿路症状无统计学意义(P＞0.05).结论 VUR明显常见于白天尿失禁的遗尿患儿,建议存在白天尿失禁的遗尿患儿进一步进行相关检查.当前尿路感染是遗尿患儿发生VUR的高危因素.     

Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection?

Aim: The aim of this study was to estimate the value of identifying vesicoureteral reflux (VUR) on a voiding cystourethrogram (VCUG) and the benefit of VUR management according to imaging strategies at the first febrile urinary tract infection (UTI). Methods: Children aged 1–144 months (n = 618) with the first febrile UTI admitted at our hospital from 2000 to 2009 were enrolled. In all patients, renal sonogram (US), ^99mTc‐dimercaptosuccinic acid (DMSA) renal scanning and VCUG were performed. Retrospective analyses per patient and per renal unit were performed. Results: Abnormal US or DMSA scans had a sensitivity of 100% and a negative predictive value (NPV) of 100% to detect high‐grade reflux. In hydronephrotic kidneys, DMSA scanning had a sensitivity of 88.2% and a NPV of 97.1% to detect high‐grade reflux. Conclusion: Routine VCUG is not required after the first febrile UTI in patients with normal US or normal DMSA scan. Even if the US reveals hydronephrosis, routine VCUG is not necessary if the DMSA findings are normal. It is recommended that children who did not receive both a DMSA scan and VCUG after the first febrile UTI should be followed up over the long term.     

Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection

Aims: To determine the sensitivity, specificity, and predictive values of renal ultrasound findings for vesicoureteral reflux (VUR). Methods: Retrospective review of the ultrasound and voiding cystourethrogram (VCUG) results of 162 children under 5 years of age admitted with their first episode of urinary tract infection (UTI) over a two year period. Ultrasound findings were considered suggestive of VUR if "dilatation of the pelvi-calyces", "dilatation of the ureters", or "dilatation of the collecting system" of one or both kidneys was reported. Results: A total of 162 patients were eligible for inclusion (median age 85 days; 71 (44%) were female). The prevalence of VUR was 22%. Ultrasound findings were positive for VUR in 14 of 35 patients with confirmed VUR on VCUG, and positive in 30 of 127 patients without VUR on VCUG. Of 21 patients who had a normal ultrasound but showed VUR on VCUG, 14 had grade II reflux, five grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 76%, respectively. The positive predictive value of ultrasound in suggesting VUR was 32%; the negative predictive value was 82%. Conclusion: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI.     

Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection.

AIMS: To determine the sensitivity, specificity, and predictive values of renal ultrasound findings for vesicoureteral reflux (VUR). METHODS: Retrospective review of the ultrasound and voiding cystourethrogram (VCUG) results of 162 children under 5 years of age admitted with their first episode of urinary tract infection (UTI) over a two year period. Ultrasound findings were considered suggestive of VUR if "dilatation of the pelvi-calyces", "dilatation of the ureters", or "dilatation of the collecting system" of one or both kidneys was reported. RESULTS: A total of 162 patients were eligible for inclusion (median age 85 days; 71 (44%) were female). The prevalence of VUR was 22%. Ultrasound findings were positive for VUR in 14 of 35 patients with confirmed VUR on VCUG, and positive in 30 of 127 patients without VUR on VCUG. Of 21 patients who had a normal ultrasound but showed VUR on VCUG, 14 had grade II reflux, five grade III reflux, and two grade IV reflux. The sensitivity and specificity of ultrasound in suggesting VUR were 40% and 76%, respectively. The positive predictive value of ultrasound in suggesting VUR was 32%; the negative predictive value was 82%. CONCLUSION: Renal ultrasound findings are neither sensitive nor specific for VUR in children with a first UTI.