Pediatric Vesicoureteral Reflux

  • Etiology: incompetent vesicoureteral valve, ureteral insertion into ureterocele or bladder diverticulum
  • VCUG: grading – Grade I (reflux only in ureter) / Grade II (reflux into non-dilated collecting system) / Grade III (reflux into mildly dilated collecting system) / Grade IV (reflux into moderately dilated collecting system) / Grade V (reflux into markedly dilated collecting system)
  • RNC: less spatial resolution than VCUG but has lower radiation dose and continuous monitoring, excellent for following reflux once it is diagnosed
  • US: artificial collagen injections at vesicoureteral valve appear as echogenic bump at base of bladder
  • Treament: lower grades of reflux can be treated temporarily with artificial collagen injections at vesicoureteral valve
  • Clinical: lower grades of reflux usually resolve on their own as patient grows older

Radiology Cases of Vesicoureteral Reflux

CT of reflux nephropathy and VCUG of vesicoureteral reflux
Coronal CT with contrast of the abdomen (left) shows a normal appearing left kidney and a shrunken right kidney with diffuse loss of renal parenchyma and scarring. AP image from a voiding cystourethrogram (right) shows left grade II vesicoureteral reflux and right grade IV vesicoureteral reflux.
US of acute pyelonephritis / acute lobar nephronia
Sagittal US of the right kidney (above) shows an ill-defined hypoechoic mass in the right upper pole that is obscuring the normal outline of the echogenic fat in the renal hilum. The mass was hypoperfused on color and power doppler US. AP image from a voiding cystourethrogram (below) shows bilateral vesicoureteral reflux, grade II on the left and grade III on the right