Value of sonography in the diagnosis of mild, moderate and severe vesicoureteral reflux in children

This study was conducted to determine the positive predictive value (PPV) of gray scale sonography in the diagnosis of mild, moderate and severe vesicoureteral reflux (VUR). This cross-sectional descriptive analytic study was conducted in the University Clinic of Isfahan University of Medical Sciences in 2008. The study was performed on children aged two to 12 years; female children with febrile urinary tract infection (UTI) and clinical suspicion of VUR and males with history of UTI and VUR who attended follow-up during the six months study period were selected. Non-cooperative patients were excluded from the study. A total of 90 patients were studied. The data gathering method was sequential. The following sonographic parameters were assessed in all the study patients: antero-posterior pelvic diameter, distal ureteric diameter and stasis of urinary system, which were measured at rest and during and after the Valsalva maneuver. Also, the vesicoureteral junction distance and distance of vesicoureteral junction to the midline were measured on both sides at rest. We then referred them for radionuclide cystography (RNC) and the results of the two methods were compared. Data were analyzed with SPSS program and t-test and chi square formulas were used. The sensitivity of ultrasound in the diagnosis of VUR was 70.9% and the specificity was 51.4%. Thus, the PPV was 69.64% and the negative predictive value was 52.94%. Although the most definite diagnosis of VUR is made with micrurating cystoureterography or RNC, sonography may be used as the first step in evaluation for VUR, especially in high-grade VUR.