Comparison of sonicated albumin enhanced sonography to fluoroscopic and radionuclide voiding cystography for detecting vesicoureteral reflux

Purpose: We compared sonicated albumin enhanced sonography to fluoroscopic and radionuclide voiding cystography for detecting vesicoureteral reflux. Materials and Methods: After obtaining informed consent we enrolled in our study 20 patients with known or suspected vesicoureteral reflux and no contraindications to intravesical sonicated albumin. All patients underwent albumin enhanced sonography, following which 10 patients each underwent radionuclide and fluoroscopic voiding cystography. Reflux was graded by the observing radiologist and urologist. Results: In 10 patients albumin enhanced sonography demonstrated reflux in 6 of the 7 (83%) ureters in which radionuclide cystography identified reflux. In 2 patients ultrasound studies were inadequate due to excessive movement during the procedure, and the patients were classified as unevaluable. In the remaining 10 patients 12 of 20 ureters (60%) were equal in the absence or presence of and degree of reflux on enhanced sonography and voiding cystourethrography. In 6 ureters voiding cystourethrography detected reflux more readily or revealed a higher grade of reflux. Two ureters had a higher reflux grade on enhanced sonography. No adverse effects were associated with intravesical sonicated albumin. Conclusions: In experienced hands sonicated albumin enhanced sonography is safe for evaluating vesicoureteral reflux. It provides the simultaneous evaluation of renal contours, parenchyma and size in addition to bladder visualization. This new technique may prove to be useful as a followup study in patients with previously documented reflux or as a primary study for sibling screening.