Detection of Posterior Urethral Valves with Voiding Cystourethrosonography With Echo Contrast

Abstract

No AccessJournal of UrologyReflux1 Oct 2002Detection of Posterior Urethral Valves with Voiding Cystourethrosonography With Echo Contrast M. Bosio and G.A. Manzoni M. BosioM. Bosio More articles by this author and G.A. ManzoniG.A. Manzoni More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64395-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Cystosonography with echo contrast is an imaging modality developed to avoid x-ray exposure during detection of vesicoureteral reflux. The main role of cystosonography has been limited to screening for reflux in the female and for followup of both sexes. In males the radiographic voiding cystourethrogram is still considered the gold standard for urethral evaluation. We determined whether cystosonography during the voiding phase (voiding cystourethrosonography) can adequately visualize the male urethra and differentiate the normal from the obstructed urethra. Materials and Methods: 100 males underwent cystosonography with echo contrast to detect vesicoureteral reflux. During the voiding phase the urethra was studied with ultrasound. The transperineal sagittal approach was chosen because the bladder neck and proximal part of the urethra were better visualized with the probe maintained coaxial to these structures. In every case in which ultrasound urethral imaging was considered abnormal a radiographic voiding cystourethrogram was performed for comparison, and the urethra was directly observed with cystourethroscopy. All patients with normal urethral imaging have been followed for 12 to 54 months (mean 32). Results: Voiding cystourethrosonography visualized the voiding phase in all patients studied with the transperineal ultrasound approach. Of the 100 boys 8 were correctly diagnosed with posterior urethral valves. None of those with normal ultrasound imaging showed clinical signs suggestive of urethral obstruction and remained asymptomatic. Conclusions: The male posterior urethra can be effectively visualized with voiding cystourethrosonography, which can differentiate normal from the pathological obstructive urethral findings. This new approach can be recommended as the primary imaging modality to detect vesicoureteral reflux for both sexes, limiting the role of conventional fluoroscopic voiding cystourethrogram only to confirmation of a pathological finding in the male patient with a suspected obstructed urethra. References 1 : Sonography with sonicated albumin in the detection of vesicoureteral reflux. J Urol1993; 150: 756. Link, Google Scholar 2 : Comparison of sonicated albumin enhanced sonography to fluoroscopic and radionuclide voiding cystography for detecting vesicoureteral reflux. J Urol1998; 160: 1820. Link, Google Scholar 3 : Cystosonography with echocontrast: a new imaging modality to detect vesico-ureteral reflux in children. Pediatr Radiol1998; 28: 250. Google Scholar 4 : Reflux in young patients: comparison of voiding US of the bladder and retrovesical space with echo enhancement versus voiding cystourethrography for diagnosis. Radiology1999; 210: 201. Google Scholar 5 : Contrast-enhanced sonography of vesicouretero-renal reflux in children: preliminary results. AJR Am J Roentgenol1999; 173: 737. Google Scholar 6 : Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol1993; 23: 478. Crossref, Medline, Google Scholar 7 : Echo-enhanced ultrasound voiding cystography in children: a new approach. Pediatr Nephrol2000; 14: 297. Google Scholar 8 : Cystosonography with echoenhancer. A new imaging technique for the diagnosis of vescicoureteral reflux objective. An Esp Pediatr2000; 53: 422. Google Scholar 9 : Long-term outcome of boys with posterior urethral valves. Br J Urol1988; 62: 59. Crossref, Medline, Google Scholar 10 : Congenital reflux nephropathy: a follow-up of 108 cases diagnosed prenatally. Br J Urol1998; 82: 252. Google Scholar 11 Troeger J. Muller N. Hohenfellner R. Sonographic findings of the urinary tract in boys with urethral valves. Proceedings of 2nd European meeting on sonographic diagnosis of vesicoureteral reflux, A 14, Heidelberg, 2000 Google Scholar 12 : Voiding cystourethrography in children: value of digital fluoroscopy in reducing radiation dose. AJR Am J Roentgenol1992; 158: 137. Google Scholar 13 : Pediatric vesicoureteral reflux guidelines panel summary report on the management of primary vesicoureteral reflux in children. J Urol1997; 157: 1846. Link, Google Scholar From the Section of Pediatric Nephrology, Department of Pediatrics and Advanced School of Pediatric Echography (SIUMB), Ospedale di Magenta, and Section of Pediatric Urology, Department of Urology, Ospedale di Circolo-Varese, Italy© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 168Issue 4 Part 2October 2002Page: 1711-1715 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsultrasonography, vesico-ureteral refluxurethraMetricsAuthor Information M. Bosio More articles by this author G.A. Manzoni More articles by this author Expand All Advertisement PDF downloadLoading ...