Ultrasound as a diagnostic tool for vesicoureteral reflux grade in children: A comparative study with voiding cystourethrography

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Abstract
Objective: Vesicoureteral reflux (VUR) is a prevalent congenital anomaly in children, with a higher incidence in those with febrile urinary tract infections. Early detection and management of VUR are crucial to prevent reflux nephropathy and its associated complications. This retrospective observational study aimed to evaluate the accuracy and advantages of ultrasonography (USG) in diagnosing VUR grade compared to voiding cystourethrography (VCUG), the gold standard. Material and Methods: The study included 147 children aged 0-5 years who underwent VCUG for urinary tract infections, as well as antenatal and postnatal hydronephrosis. Patients were categorized into two age groups: 0-24 months (Group 1) and 25-60 months (Group 2). USG findings, including parenchymal thickness, renal pelvis anteroposterior diameter, renal parenchymal echogenicity, and distal ureteral dilatation, were compared between low-grade and high-grade VUR in both groups. Results: Binary logistic regression analysis revealed that renal pelvis anteroposterior diameter and distal ureteral dilatation were independently associated with high-grade VUR in Group 1. The optimal cut-off value of renal pelvis anteroposterior diameter for predicting high-grade VUR was 5 mm, with 78.0% sensitivity and 76.0% specificity. However, no USG findings were independently associated with high-grade VUR in Group 2. Conclusion: USG examinations performed by experienced radiologists can effectively decrease radiation exposure in children, especially those with high-grade VUR under two years of age, and may prevent unnecessary radiation exposure in some pediatric patients