Voiding cystourethrosonography for the diagnosis of vesicoureteral reflux in a developing country

The primary causes of renal insufficiency in Albanian children are reflux nephropathy and obstructive uropathies. The poor availability and technical quality of conventional radiological imaging in detecting vesicoureteral reflux (VUR) and lower urinary tract obstruction stimulated this pilot study, with the aim of evaluating the diagnostic efficacy of voiding cystourethrosonography (CUS). The study included 34 patients (aged 0.1–14 years) with acute pyelonephritis, 7 of whom already had renal insufficiency. In 22 patients voiding cystourethrography (VCUG) was also performed and a diagnostic concordance of 66.6% between the two techniques was found. Overall CUS showed a sensitivity superior to VCUG in detecting VUR, partly due to technical problems in performing the fluoroscopic examination. For the same reasons, VCUG missed 1 diagnosis of posterior urethral valves, while CUS correctly identified all 4 patients with this diagnosis. In 34 patients, CUS diagnosed 55 cases of grade II–V VUR and 11 urinary tract malformations; 12 patients underwent surgical intervention, some of them on the basis of CUS only. The follow-up of 31–81 (mean 53) months after CUS was completed by 94% of patients, excluding complications due to missed diagnoses. CUS was demonstrated to be a safe, reliable, and reproducible imaging modality without X-ray hazards that could be useful in developing countries. The potential limiting factors of the technique include the operator’s training and experience and the costs of the contrast medium.