Reflux in young patients: Comparison of voiding US of the bladder and retrovesical space with echo enhancement versus voiding cystourethrography for diagnosis

PURPOSE: To compare the usefulness of voiding US of the bladder and retrove sical space with echo enhancement with that of voiding cystourethrography ( VCUG) for diagnosis of vesicoureteral reflux (VUR) and to assess patient to lerance of the echo-enhancing agent. MATERIALS AND METHODS: One hundred eighty-eight patients (aged 5 days to 20 years) referred for investigation of VUR underwent voiding US with echo en hancement, which was followed by VCUG in 100 patients (226 kidney-ureter un its). After US of the renal tract, the bladder was filled with normal salin e solution. Then SH U 508 A, a galactose-based, microbubble-containing echo -enhancing agent, was administered. Reflux was diagnosed when microbubbles appeared in the ureter or pelvicalyceal system. RESULTS: VUR was detected in 80 of the units with one (n = 18) or both (n = 62) methods. All grades of reflux were identified. In 15 units, reflux dia gnosed avoiding US was not observed at VCUG; the reverse was true in three units. In 208 (92%) of the 226 kidney-ureter units, there was concordance b etween the two methods regarding the diagnosis or exclusion of VUR. The ech o-enhancing agent was well tolerated. CONCLUSION: SH U 508 A enhanced voiding US is as good VCUG in the detection or exclusion of VUR and thus will make it possible to reduce the number of children having to be exposed to ionizing radiation.