Reduction in voiding cystoruethrographies after the introduction of contrast enhanced sonographic reflux diagnosis

Background: Voiding urosonography (VUS) using the intravesical application of an US contrast medium (Levovist) has been shown to have very high sensit ivity and specificity in the diagnosis of vesicoureteric reflux (VUR) compa red to voiding cystourethrography (VCUG). Objective: To determine the extent of reduction of VCUGs after adding VUS t o the diagnostic algorithm of VUR. Materials and methods: Over 2 years, 449 children (162 boys, 287 girls) wer e referred for diagnosis of possible VUR. The selection of a particular ref lux examination was based on pre-defined criteria. VUS was performed primar ily in girls and follow-up cases. The indications for VCUG were as follows: (a) boys first examination for VUR, (b) specific request for urethra or bl adder imaging, (c) girls - when VUR was diagnosed in the VUS and no VCUG ha d been done previously, and (d) inadequate VUS. Results: VCUGs were primarily carried out in 141 cases. VUSs were performed in 308 patients. In 69 of these patients a VCUG followed during the same e xamination session. Thus 239 of 449 patients underwent only VUS, resulting in reduction of the VCUGs by 53%. Conclusions: The number of VCUGs was significantly reduced as a result of t he implementation of VUS as part of the routine diagnostic imaging modality for VUR. Consequently, the number of children that would have been exposed to ionising radiation was reduced by over half.