The value of the sonographic appearance of the deflux deposit following endoscopic VUR-therapy in respect of therapeutic success

PURPOSE

Is there a connection between the quality of the deposit shown by a sonogram examination and proven reflux in an MCUG?

MATERIAL AND METHODS

Between 2003 and 2006, 141 ureteric orifices (73 patients, mean age 57 months, 41 bilateral VUR) underwent endoscopic anti-reflux correction (SDIN). 3 months after the procedure the control VCUG and ultrasound examinations were repeated. The results were graded as no reflux, improved or persistent reflux and were correlated with the ultrasound appearance of the deflux deposit: “well-definable” (>/=8mm), “moderately definable” (< 8mm and > 5 mm), “no evident deposit”. Evaluation of the clinical course, renal function (DMSA) and special anatomic conditions were included in this retrospective study.

RESULTS

After 1.2 times SDIN per orifice 86% of the primary refluxiving ostia was reflux-free. Where the deposit was easily definable (n=55), 87% were healed, 6% improved and 7% still refluxing In the case of a moderately definable deposit, (n=60), 71% were reflux-free, 17% improved and 12% refluxing. In the case of a non-provable deposit (n=17), 33% were healed, 11% improved and 56% unchanged (p<0.001). In all definable deposits (n = 114) 80% were healed, 11% improved and 9% unchanged. The deposits which were not definable (n = 18) revealed 33% healed, 11% improved and 56% refluxing (p = <0.001). The differences are highly significant with sensitivity of 97% and a specification of 40%.

CONCLUSIONS

The ultrasound appearance of a deposit permits a statement on the VUR course with a sensitivity of 97%, with relatively low specification. These results should be taken into account when considering when and how often a control VCUG in conformity with SDIN should be carried out.

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