[Prognostic value of the ultrasound visualization of the bulging agent after endoscopic treatment of vesicouretal reflux].
BACKGROUND
The endoscopic treatment of vesicoureteral reflux constitutes an easy and simple option at the moment for its resolution in all degrees and ages. It is necessary to carry out an ECO and VCUG (vesical cystouretrography) during voiding to verify their resolution. The ultrasongraphy can detect the wheal of injected material (Teflon or Macroplastic), but it is ignored if its visualization implies its disappearance or not.


OBJECTIVE
To see the correspondence or not between the sonographic presence of injected material wheal and disappearance of reflux in the VCUG.


METHODS
It has been statistically selected a sample of convenience to calculate the sensibility and specificity of the sonographic visualization of the endoscopic injected material wheal. We have studied 115 ureters with all the reflux degrees and ages, chosen randomly among patients treated endoscopically of vesicoureteral reflux, independently of the injected material, polytetrafluoroethylene (Teflon) or polydimethylsiloxane (Macroplastic). Refluxes due to duplex systems and those in which there were doubts of their correct installation during endoscopy were rejected. Cases with two or more injections were rejected too. The ECO and corresponding cystographies were revised in the first control after treatment (three months later). With this data, a chart of 2X2 was built comparing the presence or not of wheal in the ECO with the presence or not of reflux in the VCUG. We calculate sensibility, specificity, PPV (positive predictive value) and NPV (negative predictive value) as well as the degree of agreement of both tests with the kappa index.


RESULTS
In 115 ureteral units we visualized with ECO the wheal of injected material in 97 and not in 18 (16%). In those cases with visualized wheal, reflux disappeared in 59 (61%), and in 38 not (39%). In those cases where the wheal was not visualized, reflux disappeared in 13 and persisted in other 5 (28%). The degree of sensibility was 12%, the specificity 82%, the PPV 22% and the NPV 61%.


CONCLUSIONS
Attending to the low specificity and predictive values, the sonographic presence of material wheal doesn't indicate that the reflux has been corrected, as well as its absence doesn't reflect the presence of the same one, being always necessary to carry out a cystography for its diagnosis.
Gómez Fraile
A
A
Sección de Urología Pediátrica. Hospital Materno-Infantil 12 de Octubre, Madrid.
Suárez Charnenco
A
A
Aransay Bramtot
A
A
López Vázquez
F
F
Serrano
C
C
D002648:Child; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage; D006801:Humans; D015552:Injections, Intralesional; D011138:Polytetrafluoroethylene / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000628:therapy*
D004129:Dimethylpolysiloxanes; D011138:Polytetrafluoroethylene