title: Vesicoureteral reflux: can the urethra be adequately assessed by using contrast-enhanced voiding US of the bladder?
abstract: OBJECTIVE
  To prospectively evaluate contrast material-enhanced voiding ultrasonography (US) for assessment of the urethra by using voiding cystourethrography (VCUG) as the reference standard.
  
  
  METHODS
  This study was approved by the ethics committee on human research. Written informed consent was obtained for all patients. A total of 146 pediatric patients suspected of having vesicoureteral reflux underwent US with a galactose-based contrast agent. The bladder was instilled with contrast agent and then filled with saline. US images of the urethra were videotaped before catheterization and during voiding. VCUG was subsequently performed in all patients. In female patients, the probe (a 3.5- or 5-MHz sector array or a 7.5-MHz linear transducer) was positioned longitudinally between the labia. In male patients, the transducer was placed longitudinally on the scrotum and then displaced distally toward the penile urethra. During voiding, attention was focused on the distention of the urethral walls and on the caliber of both the posterior and anterior urethra, which were measured with calipers. Sensitivity and specificity were estimated by using a confidence interval (CI) of 95%.
  
  
  RESULTS
  All female patients and 75 male patients showed a normal urethra at both US and VCUG. Posterior urethral valves (PUV) were diagnosed in three patients at voiding US and were confirmed with findings from VCUG. Urethral stenosis was diagnosed in two male patients at voiding US and was confirmed with findings from VCUG. Seven male patients who had undergone surgery for PUV were adequately evaluated with both modalities. Sensitivity of voiding US was 100% (CI 95%: 96.5%, 100%); specificity was 100% (CI 95%: 69.9%, 100%).
  
  
  CONCLUSIONS
  Voiding US is a reliable imaging modality for studying the urethra.
authors.affiliation: Department of Pediatric Radiology, University Hospital La Paz, Paseo de la Castellana 246, 28046 Madrid, Spain. tberrocal.hulp@salud.madrid.org
authors.forename: Teresa
authors.initials: T
authors.lastname: Berrocal
authors.forename: Francisco
authors.initials: F
authors.lastname: Gayá
authors.forename: Antonia
authors.initials: A
authors.lastname: Arjonilla
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003287:Contrast Media; D004548:Elasticity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012680:Sensitivity and Specificity; D014159:Transducers; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging*; D014554:Urination / Q000502:physiology; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000503:physiopathology*
chemical_list: D003287:Contrast Media