Kuzmanovska Dafina, Risteski Aleksandar, Kambovska Margarita, Trpcevski Tase, Sahpazova Emilija, Petrovski Mile
University Children's Hospital, Medical Faculty, Ss Cyril and Methodius University of Skopje, Vodnjanska 17, Skopje, Republic of Macedonia.
Private Hospital Plodnost, ASNOM 9, Bitola, Republic of Macedonia.
Open Access Maced J Med Sci. 2017 Apr 11;5(2):215-221. doi: 10.3889/oamjms.2017.055. eCollection 2017 Apr 15.
Vesicoureteric reflux (VUR) is an important association of paediatric urinary tract infection (UTI) found in 30-50% of all children presenting with first UTI. Contrast-enhanced voiding ultrasonography (ceVUS) has become an important radiation-free method for VUR detection in children. Its sensitivity in detecting VUR has greatly improved due to the development of the contrast-specific ultrasound techniques and the introduction of the second-generation ultrasound contrast agent, superseding the diagnostic accuracy of standard radiological procedures.
This article aimed to summarise the current literature and discuss the first local pilot study performed in our institution on detection of vesicoureteric reflux by contrast-enhanced voiding ultrasonography with second- generation agent (SonoVue, Bracco, Italy).
Retrospective review of the first 31 ceVUS (24 girls, 7 boys) was presented. Age range was 2 months to 18 years (mean = 6.4 ± 4.9).
All examinations were well tolerated without any adverse incident. VUR was shown in 20 (64.5%) children in 32/62 (51.6) nephroureteral units (NUUs). In 18 NUUs, VUR was grade II/V, in 11 Grade III/V and in 3 grade IV/V, respectively. Urethra was shown in 19/31 children and in all boys, without pathological finding. In two girls spinning top urethra has been detected. Subsequent urodynamic studies revealed functional bladder problem in both.
Contrast-enhanced voiding urosonography using intravesical second generation ultrasound contrast agent could be recommend as a valid alternative diagnostic modality for detecting vesicoureteral reflux and evaluation of the distal urinary tract in children, based on its radiation-free, highly efficacious, reliable, and safe characteristics.
膀胱输尿管反流（VUR）是小儿尿路感染（UTI）的一个重要关联因素，在所有首次出现UTI的儿童中，有30%-50%可发现该情况。对比增强排尿超声检查（ceVUS）已成为检测儿童VUR的一种重要的无辐射方法。由于对比特异性超声技术的发展以及第二代超声造影剂的引入，其检测VUR的敏感性有了很大提高，超过了标准放射学检查的诊断准确性。
本文旨在总结当前文献，并讨论在我们机构进行的第一项关于使用第二代造影剂（声诺维，意大利博莱科公司）通过对比增强排尿超声检查检测膀胱输尿管反流的本地初步研究。
对前31例ceVUS检查（24例女孩，7例男孩）进行回顾性分析。年龄范围为2个月至18岁（平均=6.4±4.9）。
所有检查耐受性良好，未发生任何不良事件。62个肾输尿管单位（NUUs）中的32个（51.6%）在20例（64.5%）儿童中显示有VUR。在18个NUUs中，VUR为II/V级，11个为III/V级，3个为IV/V级。19/31例儿童及所有男孩显示尿道正常，无病理发现。在两名女孩中检测到旋转顶尿道。随后的尿动力学研究显示两人均存在功能性膀胱问题。
基于其无辐射、高效、可靠和安全的特点，使用膀胱内第二代超声造影剂的对比增强排尿超声检查可作为检测儿童膀胱输尿管反流和评估远端尿路的一种有效的替代诊断方法。
