Bedeutung der Miktionsurosonographie in der Diagnostik von Harnwegsinfektionen und bei angeborenen Fehlbildungen der Niere und ableitenden Harnwege im Kindesalter

Introduction Vesicoureteral reflux (VUR) is defined as the retrograde influx of urine from the bladder to the ureters or to the renal pelvis and calyces. VUR is associated with urinary tract infections (UTI) and congenital urogenital anomalies. Voiding cystourethrography (VCUG) used to be the gold standard for diagnosing VUR. However, because of the associated radiation exposure, the importance of VCUG has decreased in the clinical practice. Thus, voiding urosonography (VUS) has emerged as it allows for radiation-free detection and the reliable classification of different grades of reflux. However, according to current recommendations from the American Academy of Pediatrics and the National Institute for Health and Care Excellence, conventional ultrasound examination is the only primary diagnostic method of choice for children following their first UTI or those with congenital anomalies. Only if sonographic irregularities are observed, further diagnostics is prompted. Timely identification of VUR, however, is critical for the initiation of the appropriate therapy. In this study, we evaluated the detection of VUR using conventional ultrasound as well as VUS to determine the significance of VUS as a diagnostic tool. We assumed that by using only conventional ultrasound, not all relevant grades of VUR would be detected. Therefore, we believe, that the significance of CUS as a complimentary diagnostic modality has increased, and, as its radiation-free, should be preferred to VCUG. Methods We retrospectively analyzed data from 225 patients, who had presented to Vivantes Klinikum Neukölln between 2016 and 2020 with a first or recurring UTI (n=200) or with a suspected congenital urogenital anomaly (n=25), in which VUS was performed in addition to conventional ultrasound of the kidney and urinary tract. Results In our cohort, 95 (≙ 42,2%) female and 130 (≙ 57,8%) male patients were included. Their median age was 4 months (range between 11 days and 9 years). Out of 157 patients with normal findings in the conventional renal and urinary tract sonography, VUR grade I-V was shown in 67 (≙42,7%) patients, and VUR grade III and higher in 42 (≙26,8%) patients following VUS. The sensitivity of the detection of VUR using conventional ultrasound was only 40% (specificity 70%). There was no patient with normal sonography findings and VUR ≥ grade III in the suspected congenital anomaly group. Had only conventional ultrasound been performed, VUR ≥ grade III would have remained undetected in 26,8% of patients in the UTI group. Without the additional use of VUS, those patients wouldn’t have received adequate therapy. Conclusion In summary, we were able to show the benefits of establishing VUS as a complementary diagnostic tool, alongside conventional ultrasound examination, in patients following UTI. Additional VUS allows for the early detection of VUR and helps to quickly initiate optimal therapy, which is can contribute to avoid potentially irreversible damage to the kidneys and urinary tract.

Author dc:creator

• Rastin, Sanaz

• urinary tract infection
• vesicoureteral reflux
• voiding urosonography
• congenital urogenital anomalies

Licence dc:rights.uri

• http://www.fu-berlin.de/sites/refubium/rechtliches/Nutzungsbedingungen

Language dc:language

ger

Identifier URI

http://dx.doi.org/10.17169/refubium-40274

OAI record oai:identifier

https://refubium.fu-berlin.de/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Arefubium.fu-berlin.de%3Afub188%2F40554