Abstract

Objective: Vesicoureteral reflux (VUR) is a prevalent congenital anomaly in children, with a higher incidence in those with febrile urinary tract infections. Early detection and management of VUR are crucial to prevent reflux nephropathy and its associated complications. This retrospective observational study aimed to evaluate the accuracy and advantages of ultrasonography (USG) in diagnosing VUR grade compared to voiding cystourethrography (VCUG), the gold standard.

Material and Methods: The study included 147 children aged 0-5 years who underwent VCUG for urinary tract infections, as well as antenatal and postnatal hydronephrosis. Patients were categorized into two age groups: 0-24 months (Group 1) and 25-60 months (Group 2). USG findings, including parenchymal thickness, renal pelvis anteroposterior diameter, renal parenchymal echogenicity, and distal ureteral dilatation, were compared between low-grade and high-grade VUR in both groups.

Results: Binary logistic regression analysis revealed that renal pelvis anteroposterior diameter and distal ureteral dilatation were independently associated with high-grade VUR in Group 1. The optimal cut-off value of renal pelvis anteroposterior diameter for predicting high-grade VUR was 5 mm, with 78.0% sensitivity and 76.0% specificity. However, no USG findings were independently associated with high-grade VUR in Group 2.

Conclusion: USG examinations performed by experienced radiologists can effectively decrease radiation exposure in children, especially those with high-grade VUR under two years of age, and may prevent unnecessary radiation exposure in some pediatric patients.

Keywords: Contrast Media, diagnostic imaging, ultrasonography, vesico-Ureteral Reflux, radiography

References

  1. Begum R. Pediatric Vesico-Ureteral Reflexes: Current Management. medtigo Journal. 2024;2(1). https://doi.org/10.63096/medtigo3062212
  2. Oktar T, Selvi I, Dönmez Mİ, Gürcan M, Aydınoğlu AT, Ziylan O. Transitional outcomes of adults who underwent Cohen ureteroneocystostomy for the treatment of vesicoureteral reflux as children. Urology. 2025 Apr:198:106-114. https://doi.org/10.1016/S0302-2838(24)00695-X
  3. Pakkasjärvi N, Belov S, Jahnukainen T, Kivisaari R, Taskinen S. Stratifying Antenatal Hydronephrosis: Predicting High-Grade VUR Using Ultrasound and Scintigraphy. Diagnostics. 2024;14(4):384. https://doi.org/10.3390/diagnostics14040384
  4. Puri P, Friedmacher F, Farrugia M-K, Sharma S, Esposito C, Mattoo TK. Primary vesicoureteral reflux. Nature Reviews Disease Primers. 2024;10(1):75. https://doi.org/10.1038/s41572-024-00560-8
  5. Roberts KB, Subcommittee on Urinary Tract Infection SCoQI, Management. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. American Academy of Pediatrics Elk Grove Village, IL, USA; 2011; 595-610. https://doi.org/10.1542/peds.2011-1330
  6. Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE. International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol. 1985;15(2):105-9. https://doi.org/10.1007/BF02388714
  7. e Silva ACS, Jabour LGPP, Vieira BCC, Oliveira EA. Imaging investigation after urinary tract infection in childhood: narrative review of current recommendations. Pediatric Medicine. 2023;6:17 https://doi.org/10.21037/pm-21-86
  8. Blais AS, Bolduc S, Moore K. Vesicoureteral reflux: From prophylaxis to surgery. Can Urol Assoc J. 2017;11(1-2Suppl1):S13-s8. https://doi.org/10.5489/cuaj.4342
  9. Emma F, Goldstein SL, Bagga A, Bates CM, Shroff R. Pediatric nephrology: Springer Nature; 2022. https://doi.org/10.1007/978-3-030-52719-8
  10. Chang J-W, Liu C-S, Tsai H-L. Vesicoureteral reflux in children with urinary tract infections in the inpatient setting in Taiwan. Clinical epidemiology. 2022;14:299-307. https://doi.org/10.2147/CLEP.S346645
  11. Naseri M, Tafazoli N, Tafazoli N. Prevalence of Vesicoureteral Reflux in Children with Urinary Tract Infection. Saudi J Kidney Dis Transpl. 2022;33(Suppl 2):S111-S20. https://doi.org/10.4103/1319-2442.384183
  12. Su D, Zhuo Z, Zhang J, Zhan Z, Huang H. Risk factors for new renal scarring in children with vesicoureteral reflux receiving continuous antibiotic prophylaxis. Sci Rep. 2024;14(1):1784. https://doi.org/10.1038/s41598-024-52161-w
  13. Han DS, Cambareri G, Alagiri M, Chiang G. Reflux timing is a predictor of successful endoscopic treatment of vesicoureteral reflux. Urology. 2019;124:237-40. https://doi.org/10.1016/j.urology.2018.09.034
  14. Ripatti L, Viljamaa H-R, Kauko T, Kytö V, Rautava P, Sipilä J, et al. Trends in the surgical management of vesicoureteral reflux in Finland in 2004-2014. Scand J Urol. 2021;55(1):67-71. https://doi.org/10.1080/21681805.2020.1849387
  15. Doğan GM, Sığırcı A, Elmas AT, Tabel Y. The role of ultrasound in the diagnosis of vesicoureteral reflux disease. J Surg Med. 2022;6(2):102-5. https://doi.org/10.28982/josam.1023251
  16. Bayram Ilıkan G. How Can We Specify The Role of Ultrasonography in the Vesico – Ureteral Reflux Disease?. Turkish J Pediatr Dis 2020; 14:348-351. https://doi.org/10.12956/tchd.733936
  17. You SK, Kim JC, Park WH, Lee SM, Cho H-H. Prediction of High‐grade Vesicoureteral Reflux in Children Younger Than 2 Years Using Renal Sonography: A Preliminary Study. JUM 2016;35(4):761-5. https://doi.org/10.7863/ultra.15.04074
  18. Khater HM, Ali Aaef, M Sweed E. Is Ultrasound Adding Values to Voiding Cystourethrogram In Pediatric Vesico Ureteric Reflux? Benha Medical Journal. 2024;41(7):48-58.
  19. Nelson CP, Johnson EK, Logvinenko T, Chow JS. Ultrasound as a screening test for genitourinary anomalies in children with UTI. Pediatrics. 2014;133(3):e394-e403. https://doi.org/10.1542/peds.2013-2109
  20. Hodhod A, Capolicchio J-P, Jednak R, El-Sherif E, El-Doray AE-A, El-Sherbiny M. Influence of postnatal hydroureter in determining the need for voiding cystourethrogram in children with high-grade hydronephrosis. Arab J Urol. 2018;16(2):238-44. https://doi.org/10.1016/j.aju.2017.11.004

Copyright and license

Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Taş N, Özlü SG, Çiftci N, İnözü M, Yüksel Aksoy Ö, Yazıcıoğlu B, et al. Ultrasound as a diagnostic tool for vesicoureteral reflux grade in children: a comparative study with voiding cystourethrography. Turk J Pediatr Dis [Internet]. 2025 Jul. 10 [cited 2025 Aug. 23];. Available from: https://turkjpediatrdis.org/article/view/1152