A noninvasive test for vesico-ureteric reflux in children

R. A. Mevorach, B. Cilento, S. Zahorian, C. Badgett, R. Walker, A. Atala, S. Iannello, M. Meyer

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective: To report the development and testing of a device for the noninvasive diagnosis of vesico-ureteric reflux (VUR) which avoids the need for urethral catheterization (currently required to reliably determine the presence of VUR), and which thus avoids the anxiety of parents and patients that causes many families to refuse such evaluation. Patients and methods: Fifty-four children (49 girls and five boys, mean age 7.2 years, range 4-14) previously evaluated as having VUR volunteered to participate; no child was symptomatic at the time of the study. Refluxing units were known to be present by voiding cysto-urethrography (within 1 year, mean 7 months) in 45 and absent in 16. The device developed acquires electronically processed acoustic signals from the child during an observed urination. The signals are then analysed 'off-line' to determine the presence or absence of VUR. The initial preparation for the test included: (i) a full bladder [at least 0.80 × {(2 + age) × 30 mL}] measured by ultrasonography; and (ii) localization of the pelvi-ureteric junction by ultrasonography to accurately place the device's sensors on the child's back. The children were then positioned at a commode after placing the sensors: the recording was started and continued until voiding occurred. The children were tested with the recording and analysis team unaware of the presence and/or degree of VUR. The first 47 studies were single-kidney examinations and the remaining seven included simultaneous monitoring of both kidneys. Results: Sixty-one renal units were assessed and interpretable signals were obtained from 54 (89%). There were seven episodes of 'system failure' when no interpretable data were obtained. One unit with no VUR had a 'reflux' signal: in four kidneys, spontaneous (two) and postsurgical (two) resolution of reflux was predicted by the testing and subsequently verified by cyclic radionuclide cystography. Conclusions: This noninvasive diagnostic technique detected VUR in 35 of 37 refluxing units and verified no reflux in 16 of 17 units without VUR. Further refinements may allow this technology to be used in all children with suspected VUR.

Original languageEnglish (US)
Pages (from-to)467-472
Number of pages6
JournalBJU International
Volume87
Issue number6
DOIs
StatePublished - 2001
Externally publishedYes

Keywords

  • Acoustic
  • Diagnosis
  • Noninvasive test
  • Vesico-ureteric reflux

ASJC Scopus subject areas

  • Urology

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