ESPN 50th Annual Meeting

ESPN 2017


 
Value of renal and bladder ultrasound in diagnosing vesicouretral reflux
EL AMOURI AMINA 1 MAUEL REINER 1 ERNST CAROLINE 2 MEESTERS KEVIN 1

1- DEPARTMENT OF PEDIATRICS, UNIVERSITAIR ZIEKENHUIS BRUSSEL, VRIJE UNIVERSITEIT BRUSSEL, BRUSSELS (BELGIUM)
2- DEPARTMENT OF RADIOLOGY, UNIVERSITAIR ZIEKENHUIS BRUSSEL, VRIJE UNIVERSITEIT BRUSSEL, BRUSSELS (BELGIUM)
 
Introduction:

Continuous antibiotic prophylaxis reduces the incidence of recurrent pyelonephritis in children with vesicouretral reflux (VUR). However, there is an ongoing debate on which children should be screened for VUR after a first episode of pyelonephritis. More concrete, the value of renal and bladder ultrasound (RBUS) in diagnosing VUR has been challenged. In this abstract, we present our preliminary findings of a database study in children younger than 4 years of age.

Material and methods:

Retrospective analysis of patients younger than 4 years who were followed-up at our department, after a first episode of pyelonephritis, between 2009-2015. Patients were included if clinical information concerning index pyelonephritis, and paired RBUS and voiding cystourethrogram (VCUG) were available. Patients were excluded if a VCUG had been performed preceding index pyelonephritis. Descriptive statistics and logistic regression models were used for examining risk factors for VUR, SPSS version 22 was used for performing all analyses.

Results:

Data of 399 children were available for analysis. Escherichia coli was cultured in 345 cases (86.4%). Hydroureters and duplex ureters were found in 25 renal units (3.1%), any grade of VUR in 179 units (22.4%), dilating VUR in 74 units (9.2%). In our first logistic regression analysis, girls, index infections with non-E. coli pathogens, and duplex ureters were risk factors for any grade of VUR. In general, ultrasound parameters were not significantly predictive for VUR. In VUR cases that were missed by RBUS (124), bladder was empty at RBUS in 76 children (73.1%).

 

Conclusions:

 Girls, and children suffering pyelonephritis by non-E.coli uropathogens are at risk for VUR in children less than 4 years. RBUS is of limited value in diagnosing VUR.