Dynamic and static ultrasound features predictive of vesicoureteral reflux and renal damage in children and adolescents with neurogenic bladder

• Published in: International Brazilian Journal of Urology 2023-11, Vol.49 (6), p.700-715
• Main Authors: da Silva, Carlos Magno Paiva, de Almeida Vasconcelos, Mônica Maria, Lima, Eleonora Moreira, de Bessa Junior, José, Reis, Otávio Augusto Fonseca, Filgueiras, Maria Francisca Tereza Freire, de Azevedo, Roberta Vasconcellos Menezes, Bastos Netto, José Murillo, Oliveira, Eduardo Araújo, de Carvalho Mrad, Flávia Cristina
• Format: Article
• Language: English
• Subjects: Meningomyelocele; Neurogenic; Original; Urinary Bladder; Vesico-Ureteral Reflux
• ISSN: 1677-5538; 1677-6119
• DOI: 10.1590/s1677-5538.ibju.2023.0311

ABSTRACT Purpose: This study aimed to analyze the diagnostic accuracy of dynamic and static ultrasound (DSUS) in detecting vesicoureteral reflux (VUR) and renal scarring in a cohort of children with neurogenic bladder (NB). Materials and Methods: A retrospective, longitudinal, observational study was conducted using the Reporting Diagnostic Accuracy Studies guideline. The DSUS (index test) data were compared with voiding cystourethrography (VCUG) and renal scintigraphy 99mTc-dimercaptosuccinic (reference tests). Overall performance for predicting VUR and renal scarring was assessed using renal pelvic diameter (RPD)/distal ureteral diameter and renal parenchymal thinning on DSUS, respectively. Results: A total of 107 patients (66 girls, median age 9.6 years) participated. Seventeen patients (15.9%) presented VUR, eight bilateral. For overall reflux grade, the AUC was 0.624 for RPD and 0.630 for distal ureteral diameter. The diagnostic performance for detecting high-grade VUR was slightly better for DSUS parameters. The AUC was 0.666 for RPD and 0.691 for distal ureteral diameter. The cut-offs of 5 mm for RPD and 6.5 mm for distal ureteral diameter presented the best diagnostic odds ratio (DOR) to identify high-grade VUR. The increase of RPD during detrusor contractions showed an accuracy of 89.2%. The thinness of renal parenchyma presented an accuracy of 88% for renal scarring. Conclusion: DSUS predicts VUR and renal scarring in children with NB with fair to good accuracy, and all measurements exhibited a high negative predictive value (NPV). The increase in RPD during voiding or detrusor contractions proved to be the most accurate parameter for indicating the presence of VUR in this study.