[Urethrosonocystography with galactose in the diagnosis and follow-up of pediatric patients with vesicoureteral reflux].

INTRODUCTION AND OBJECTIVES: Since early 80's, attempts to detect Vesicoureteric Reflux (VUR) with Ultrasound (US) contrast medium have been made to study the urinary tract during voiding. The galactose-based agents are comparable in the diagnostic range with the standard fluoroscopic cystography, providing high values of sensitivity and specificity. The purpose of our work is to show our experience during last three years with the urethrosonocystography with echo contrast in the diagnosis and follow-up of pediatric patients with urological malformations.

PATIENTS AND METHODS: 442 patients were included in our study (aged 1 day to 13 years; 202 males and 240 females). All cases were referred for investigation of VUR based on previous criteria of urinary tract infection, VUR follow-up, dilated urinary tract, post endoscopic treatment, surgical treatment follow-up and others. After transurethral catheterisation the bladder was filled with US galactose-based contrast medium (Levovist). VUR was diagnosed when micro bubbles appeared in ureter or pelvicalyceal system and was graded according to the International Reflux Study Committee.

RESULTS: Of the 442 patients evaluated with echo enhanced urethrosonocystography, 227 were screening cases for discard VUR. Of these patients, only 58 were diagnosed as having VUR. In 165 cases the technique was indicated as follow-up. Two patients with spina bifida developed candiduria after the sonographic cystogram. In 6 patients with dilated urinary tract without reflux, galactose was detected in renal pelvis 6 months after the procedure.

CONCLUSIONS: In our experience urethrocystosonography with galactose-based US medium agents is a more sensitive method than standard Voiding Cystourethrography (VCUG) for detecting VUR in pediatric patients. US cystography is an attractive technique which involves no ionising radiation and is usually well tolerated by the young. This procedure should be considered as a routine diagnostic work-up for detecting VUR in pediatrics.