Marzuillo Pierluigi, La Manna Angela, Palma Pier Luigi, Tirelli Paola, Di Sessa Anna, Russo Anna, Reginelli Alfonso, Roberti Agnese, Verde Laura, Guarino Stefano, Di Iorio Giovanni
Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, Naples, Italy.
Radiology Unit, Department of Precision Medicine, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy.
Pediatr Nephrol. 2025 Sep 9. doi: 10.1007/s00467-025-06901-3.
Voiding cystourethrography (VCUG) is indicated for evaluating the anatomy of the urethra and bladder. It is primarily used to diagnose vesicoureteral reflux (VUR) and posterior urethral valves (PUV), especially in cases of febrile urinary tract infections (UTIs), significant ureteral dilation on ultrasound, and-in continent children-urinary symptoms suggestive of infravesical obstruction. VCUG exposes children to a non-negligible dose of radiation and requires urethral catheterization, which can be painful-particularly in males-and carries a low but present risk of post-procedural UTI. Despite its widespread use, VCUG can miss VUR in up to 50% of cases. Moreover, recent studies report that preoperative suspicion of PUV on VCUG was present in only 46% of non-toilet-trained and 59% of toilet-trained males, likely due to challenges in interpreting the VCUG findings. In this review, we will highlight the clinical value, challenges, and areas of debate surrounding this diagnostic test, and offer practical tips to optimize its performance.
排尿性膀胱尿道造影（VCUG）用于评估尿道和膀胱的解剖结构。它主要用于诊断膀胱输尿管反流（VUR）和后尿道瓣膜（PUV），特别是在发热性尿路感染（UTI）、超声显示输尿管明显扩张以及（对于不能自主控制排尿的儿童）提示膀胱下梗阻的泌尿系统症状的情况下。VCUG会使儿童接受不可忽视的辐射剂量，并且需要进行尿道插管，这可能会很痛苦，尤其是在男性中，而且术后发生UTI的风险虽低但存在。尽管VCUG被广泛使用，但在高达50%的病例中可能会漏诊VUR。此外，最近的研究报告称，在未接受如厕训练的男性中，只有46%以及在接受如厕训练的男性中只有59%在术前通过VCUG被怀疑患有PUV，这可能是由于解读VCUG结果存在困难。在这篇综述中，我们将强调围绕这项诊断测试的临床价值、挑战和争议领域，并提供优化其性能的实用技巧。
