Cyclic voiding urosonography for detecting vesicoureteric reflux in renal transplant recipients.
BACKGROUND
The clinical significance of vesicoureteric reflux (VUR) in renal transplant recipients remains controversial. Voiding urosonography (VUS), a new modality for detecting VUR, can be used in these patients. The sensitivity of X-ray and radionuclide cystography for detecting VUR may be improved with cyclic procedures. The aim of our study was to evaluate whether cyclic VUS is superior to the single-cycle procedure.


METHODS
Cyclic VUS was performed in 27 renal transplant recipients. Eight were children or adolescents and the remaining 19 recipients were adults. VUS was performed according to accepted guidelines. After the first micturition, the catheter was left in place and the entire procedure was repeated under the same conditions.


RESULTS
Both initial cycle and cyclic VUS detected 17 out of 27 (63%) VURs in the same patients. The sensitivity was not improved by cyclic VUS. However, there were differences between the initial cycle and cyclic VUS (P=0.028) when comparing the number of negative results and the grades of VURs detected. This difference was even more pronounced when analysing only positive results. In the initial cycle, five out of 17 (29%) VURs were grade III, compared with 10 out of 17 (59%) grade III VURs in the same patients using the cyclic procedure (P=0.008).


CONCLUSIONS
Cyclic VUS did not improve the detection sensitivity for VUR in our study. However, given that VUR grade may be important for the management of renal transplant recipients, the use of cyclic VUS may provide a useful diagnostic tool for these patients.
Kenda
R B
RB
Department of Pediatric Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia. rajko.kenda@mf.uni-lj.si
Kenig
A
A
Novljan
G
G
Ponikvar
R
R
Ponikvar
J B
JB
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000592:standards; D014554:Urination; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*