Value of ultrasound in children with urinary tract infection and vesicouretric reflux

الملخص EN

Aims of the study : To assess different urological abnormalities associated with UTI in children & to determine the value of ultrasound in vesicoureteral reflux (VUR).

Patients and Methods : Retrospective study of the ultrasound and micturating cystourethrogram (MCUG) results of 80 children under 5 years of age with clinically labelled cases of first time urinary tract infection (UTI) over a 2 years period .

Thirty cases had excretory urography tailored according to the case.

The study assesses different renal, uretric and urinary bladder abnormalities associated with first time UTI in children.

Ultrasound findings were also assess VUR and suggest its presence if dilatation of the pelvi-calyces, dilatation of the ureters, or dilatation of the collecting system of one or both kidneys was reported.

Statistical analysis used include sensitivity, specificity, positive predictive value and negative predictive value.

Results: A total of 80 patients (20days-5years) (median age 18months, 42 (52 % were female), 38 (48 % were males) .

In analysis of US findings : hydronephrosis and urinary bladder mucosa thickenings (cystitis) each 28.7 % were the commonest, renal stones and congenital anomalies : 11.2 % and 10 % respectively .The urinary bladder stones were 6.2 % .

The prevalence of VUR was 25 %.

Ultrasound findings were positive for VUR in 8 of 20 patients with confirmed VUR on MCUG, and positive in 15 of 60 patients without VUR on MCUG.

Of 12 patients who had a normal ultrasound but showed VUR on MCUG, 7 had grade II reflux, 3 grade III reflux, and two grade IV reflux.

The sensitivity and specificity of ultrasound in suggesting VUR were 40 % and 80 %, respectively.

The positive predictive value of ultrasound in suggesting VUR was 34 % ; the negative predictive value was 83 %.

Conclusions : Uultrasound useful to evaluate children with diferent urological abnormalities asociated with UTI in children but its neither sensitve nor specific for VUR in children with UTI.

Clinician should not depend on ultrasound only for diagnosis of VUR and must proced to other like voiding colour Dopler US with echo enhancement or MCUG