Color Doppler ultrasonography in the assessment of vesicoureteric reflux in children with bladder dysfunction

To determine whether color Doppler ultrasound (DUS) evaluation of ureteric jets could predict vesicoureteric reflux (VUR) in children with non-neuropathic and neuropathic bladder/sphincter dysfunction, 129 children were evaluated to identify the vesicoureteric orifice and measure the distance from the orifice to the midline of the dorsal bladder wall (MVU distance). The type of bladder dysfunction was determined by urodynamic studies. Forty-two children with no history of kidney or bladder disease were examined by DUS as a control group. MVU distances were compared between several groups of children with different urodynamic findings, and the significance was tested. Jets were visualized in 81% of children. MVU distances were significantly lower in children without VUR compared to those with VUR. No statistically significant differences were observed between children without VUR and those with VUR and more severe urodynamic disturbances like dysfunctional voiding. In children with neuropathic bladders, jets were visible in only 57% of refluxive units and the range of MVU distances was very wide (5-22 mm). If a cut-off point of 10 mm is used, in children without bladder dysfunction the sensitivity of MVU measurement in the diagnosis of VUR was 87.5% and the specificity 97%. However, in children with non-neuropathic and neuropathic bladder dysfunction, the sensitivity was only 55% and the specificity 79%. Color Doppler (DUS) and measurement of the MVU distance proved useful in predicting VUR only in children with normal bladder function. In children with neuropathic and non-neuropathic bladder dysfunction it can be used to visualize ureteric jets, but cannot replace radiographic or radionuclide voiding cystourethrography.