Contrast-Enhanced Voiding Urosonography, a Possible Candidate for the Diagnosis of Vesicoureteral Reflux in Children and Adolescents; a Systematic Review and Meta-Analysis Publisher Pubmed



Yousefifard M¹ ; Toloui A¹ ; Rafiei Alavi SN¹ ; Madani Neishaboori A¹ ; Ahmadzadeh K¹ ; Ghelichkhani P² ; Safari S^{3, 4} ; Abbasi A⁵ ; Ataei N⁵ ; Hosseini M^{5, 6} Show Affiliations
Source: Journal of Pediatric Urology Published:2022

Abstract

Introduction: The diagnostic value of contrast-enhanced voiding urosonography (ceVUS) in the diagnosis of vesicoureteral reflux (VUR) is still a subject of dispute. Objective: Assessing the diagnostic value of ceVUS in VUR, performing a systematic review and meta-analysis. Methods: An extensive search on Medline, Embase, Scopus and Web of Science databases was conducted by the end of 2020. The inclusion criteria were studies on the diagnostic value of ceVUS for VUR. Two independent researchers summarized the included articles and the findings were reported as area under the curve (AUC), sensitivity and specificity with a 95% confidence interval (95% CI). Results: Finally, the data of 36 articles were included in the present meta-analysis (2768 children). The VUS assessment showed that 1297 of the cases were true positives, 3661 were true negatives, 398 were false positives and 169 were false negatives. The AUC, sensitivity and specificity of ceVUS with the first-generation contrast agent in the diagnosis of VUR in children and adolescents were obtained as 0.97 (95% CI: 0.95, 0.98), 0.92 (95% CI: 0.86, 0.96) and 0.94 (95% CI: 0.95, 0.98), respectively. Moreover, AUC, sensitivity and specificity of ceVUS with the second-generation contrast agent were 0.97 (95% CI: 0.95, 0.98), 0.93 (95% CI: 0.86, 0.97) and 0.91 (95% CI: 0.86, 0.95). Conclusion: The findings of the present study showed that diagnostic value of ceVUS with both first-generation and second-generation contrast agents for VUR, is in an excellent range. Although it seems that ceVUS may be applied as a radiation-free alternative to imaging techniques such as VCUG, the presence of 3% of false negatives in this test is a limitation. Since the lack of punctual management of VUR is associated with serious renal complications in children, future studies are recommended to be focused on the evaluation of the Benefit-risk evaluation of ceVUS. © 2021 Journal of Pediatric Urology Company