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Ultraschall Med 2022; 43(05): e73-e80
DOI: 10.1055/a-1288-0075
Original Article

Role of Contrast-Enhanced Voiding Urosonography in the Evaluation of Renal Transplant Reflux – Comparison with Voiding Cystourethrography and a New Classification

Rolle der kontrastmittelverstärkten Miktionsurosonografie bei der Bewertung des Reflux in Nierentransplantate – Vergleich mit der Miktionszystourethrografie und einer neuen Klassifikation
Francesco Maria Drudi
1   Department of Radiology, University La Sapienza, Rome, Italy
,
Flavia Angelini
1   Department of Radiology, University La Sapienza, Rome, Italy
,
Michele Bertolotto 
2   Radiology, University of Trieste, Italy
,
Antonio Granata
3   Nephrology and Dialysis Unit, “St. Giovanni di Dio” Hospital, Agrigento, Italy
,
Giovanni Battista Di Pierro
4   Department of Urology, University La Sapienza, Rome, Italy
,
Quirino Lai
5   Hepato-Biliary Surgery and Organ Transplantation Unit, University La Sapienza, Rome, Italy
,
Giuseppe D'Ermo
6   Department of Surgery “P. Valdoni”, Policlinico Umberto I, Sapienza University, Rome, Italy
,
Renzo Pretagostini
5   Hepato-Biliary Surgery and Organ Transplantation Unit, University La Sapienza, Rome, Italy
,
Vito Cantisani
1   Department of Radiology, University La Sapienza, Rome, Italy
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Abstract

Vesicoureteral reflux (VUR) is a common urological complication in renal transplant patients. The aim of this study is to evaluate the performance of contrast-enhanced voiding urosonography (CEvUS) in the diagnosis and classification of reflux into the renal allograft, to evaluate and classify VUR into the allograft using voiding cystourethrography (VCUG) and CEvUS, to compare the two methods, and to propose a new classification of reflux into the allograft based on CEvUS and VCUG assessment, in line with the international reflux grading system.

Materials and Methods From January 2017 to July 2019, 84 kidney transplant patients were enrolled. All patients underwent VCUG and CEvUS.

Results In 76 cases there was agreement between VCUG and CEvUS (90 %) (Kappa = 0.7). The sensitivity of CEvUS using VCUG as the gold standard was 90 %, and the specificity was 92 %. Of the 7 cases diagnosed by VCUG and not by CEvUS, 6 were grade 1 and 1 was grade 2.

Conclusion Transplant patients with reflux symptoms should undergo CEvUS. If the outcome is negative, VCUG should be performed. The classification that we propose is better suited to describe VUR in transplant patients, because it is simpler and takes into account whether reflux occurs not only during urination but also when the bladder is relaxed.

Zusammenfassung

Vesikoureteraler Reflux (VUR) ist eine häufige urologische Komplikation bei Patienten mit Nierentransplantation.

Ziel dieser Studie ist es, die Leistung der kontrastmittelverstärkten Miktionsurosonografie (CEmUS) bei der Diagnose und Klassifizierung des Reflux in das Nieren-Allotransplantat zu bewerten, den VUR in das Allotransplantat mittels Miktionszystourethrografie (MCU) und CEmUS zu bewerten und zu klassifizieren, die beiden Methoden zu vergleichen und eine neue Klassifikation des Reflux in das Allotransplantat basierend auf der CEmUS- und MCU-Beurteilung in Übereinstimmung mit dem internationalen Reflux-Klassifikationssystem vorzuschlagen.

Material und Methoden Von Januar 2017 bis Juli 2019 wurden 84 nierentransplantierte Patienten eingeschlossen. Bei allen Patienten wurden MCU und CEmUS durchgeführt.

Ergebnisse In 76 Fällen bestand Übereinstimmung zwischen MCU und CEmUS (90 %) (Kappa = 0,7). Die Sensitivität von CEmUS bei Verwendung der MCU als Goldstandard betrug 90 %, die Spezifität betrug 92 %. Von den 7 Fällen, die mittels MCU, aber nicht durch CEmUS diagnostiziert wurden, hatten 6 Patienten Grad 1 und 1 Patient hatte Grad 2.

Schlussfolgerung Transplantationspatienten mit Refluxsymptomen sollten sich einer CEmUS unterziehen. Wenn das Ergebnis negativ ist, sollte eine MCU durchgeführt werden. Die von uns vorgeschlagene Klassifikation ist besser geeignet, um den VUR bei Transplantationspatienten zu beschreiben, da sie einfacher ist und berücksichtigt, ob der Reflux nicht nur bei der Blasenentleerung, sondern auch bei entspannter Blase auftritt.

Key words

transplanted kidney - vesicoureteral reflux - CEvUS - VCUG - urinary tract


Publication History

Received: 05 June 2020

Accepted: 28 September 2020

Article published online:
12 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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