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Research Article Open Access
Background: Voiding urosonography (VUS) can assess vesicoureteral reflux (VUR) in children. However, during examination, the voiding phase may create management problems for the operator as well as psychological disorders for the patient.
Objective: To assess diagnostic accuracy of cystosonography with the Valsalva maneuver (Valsalvacystosonography) instead of voiding phases in the evaluation of VUR in children and compares this new technique with traditional VUS.
Materials and methods: A total of 41 kidney-ureter-units (KUU) were assessed in 22 children (11 girls and 11 boys, mean age 5.6 years old, range 4 to 9 years) who were referred to our Institution for evaluation of VUR. Clinical indications included urinary tract infection without pelvicalyceal and ureter dilatation, pelvicalyceal and ureter dilatation without urinary tract infection or both. Children were eligible if they were able to carry out the Valsalva maneuver. All patients were informed on how to perform the Valsalva maneuver before the exam was performed. Valsalva-cystosonography and VUS were consecutively carried out in the same patient. The voiding phase was performed by another examiner in all patients.
Results: VUR was detected in 16 (39%) of the 41 KUUs. In 15 KUUs (36.6%), reflux was detected with both methods. In 1 patient, grade II reflux was detected by VUS only. The agreement between VUS and Valsalvacystosonography was 0.96 (p < 0.0001), which indicates an “almost perfect agreement”. Taking the VUS as the reference standard, Valsalva-cystosonography had a sensitivity of 93.75% (95% CI 69.77% - 99.84%) and a specificity of 100% (95% CI 86.28% - 100%). The grade of VUR detected with Valsalva-cystosonography also showed moderate agreement with grading by voiding VUS [κ = 0.51, p = 0.002].
Conclusion: Our results demonstrate that the Valsalva-cystosonography is an effective approach for assessing VUR and support its potential use as an alternative to the traditional voiding phase.