Ultrasound Detection of Vesicoureteral Reflux in Children

Purpose: We present different ultrasound techniques to detect vesicoureteral reflux in children with special emphasis on voiding urosonography. Materials and Methods: Urinary tract infection is a common problem in children that may be related to vesicoureteral reflux. Currently there is no consensus on investigations in children after the first urinary tract infection. The least invasive imaging with the smallest radiation burden should be used in children. Ultrasound to detect reflux meets several of these criteria. The development of echo enhancing agents has markedly improved reflux visualization by ultrasound. Results: We discuss the clinical relevance of voiding urosonography. We reviewed the currently available literature and the results of our studies of this issue. We also describe our endeavors to avoid catheterization and detect vesicoureteral reflux based on various sonomorphological features, ie indirect voiding urosonography and ureteral jet Doppler waveform analysis, to avoid applying any substance into the bladder. Conclusions: Voiding urosonography is safe and reliable to detect vesicoureteral reflux. When indicated, considerably decreased radiation exposure can be achieved by voiding urosonography instead of established cystography methods. Indirect voiding urosonography and ureteral jet Doppler waveform analysis could be an alternative to invasive voiding cystography, at least in children older than 3 years.