Section of Radiological Sciences, Department of Biomedical, Dental Sciences and Morphological and Functional Imaging, University of Messina, "G. Martino" Policlinic, Via Consolare Valeria 1, 98100, Messina, Italy.
Unit of Pediatric Nephrology With Dialysis, Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, "G. Martino" Policlinic, Messina, Italy.
Radiol Med. 2021 Jul;126(7):901-909. doi: 10.1007/s11547-021-01360-w. Epub 2021 May 5.
Vesicoureteral reflux (VUR) is a pathological condition contradistinguished by monolateral or bilateral retrograde flow of urine from the bladder to the ureter and to the kidney. If not properly recognized and treated, VUR can potentially be associated to several complications such as recurrent infections and possible secondary scars with Chronic Kidney Disease (CKD). Furthermore, it represents an important risk factor for nephrovascular hypertension. During the last 20 years, the diagnostic approach to this entity has passed through several, drastic changes: indeed, since its introduction in 1994 contrast-enhanced voiding urosonography (ceVUS) has gradually accompanied the voiding cystourethrography (VCUG) as alternative imaging technique for the diagnosis and staging of VUR. Despite a large number of papers has strongly encouraged its use in clinical practice, due to the lack of ionizing radiations and its high sensitivity rate, to date almost all the guidelines only include the VCUG for VUR diagnosis. The introduction of technologically advanced US software and the approval of the intravesical administration of ultrasound contrast agents by the Food and Drug Administration (FDA) and by the European Medicine Agency (EMA) have to induce the Scientific Community to a deep revaluation of the role of ceVUS in the diagnosis and follow-up of VUR: urosonography might extensively replace VCUG as the reference method, reserving to cystourethrography a role in the most complex anatomic settings for pre-surgical evaluation.
膀胱输尿管反流（VUR）是一种病理性疾病，其特征为尿液从膀胱单向或双向逆行流入输尿管和肾脏。如果不及时识别和治疗，VUR 可能会导致多种并发症，如反复感染和可能的继发性瘢痕形成，进而导致慢性肾脏病（CKD）。此外，它还是肾血管性高血压的一个重要危险因素。在过去的 20 年中，该疾病的诊断方法发生了多次重大变化：实际上，自 1994 年对比增强型排尿超声检查（ceVUS）问世以来，它已逐渐取代了排尿性膀胱尿道造影术（VCUG），成为 VUR 的诊断和分期的替代影像学技术。尽管大量文献强烈鼓励将其用于临床实践，但由于缺乏电离辐射且具有较高的灵敏度，迄今为止，几乎所有指南仅将 VCUG 纳入 VUR 诊断。先进的超声技术软件的问世以及美国食品和药物管理局（FDA）和欧洲药品管理局（EMA）对膀胱内超声造影剂的批准，促使科学界重新评估 ceVUS 在 VUR 的诊断和随访中的作用：超声检查可能广泛替代 VCUG 作为参考方法，仅将其用于术前评估中最复杂的解剖结构。
