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Update on imaging recommendations in paediatric uroradiology: the European Society of Paediatric Radiology workgroup session on voiding cystourethrography

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Abstract

Voiding cystourethrography (VCUG) is a fluoroscopic technique that allows the assessment of the urinary tract, including the urethra, bladder, and—if vesicoureteral reflux (VUR) is present—the ureters and the pelvicalyceal systems. The technique also allows for the assessment of bladder filling and emptying, providing information on anatomical and functional aspects. VCUG is, together with contrast-enhanced voiding urosonography (VUS), still the gold standard test to diagnose VUR and it is one of the most performed fluoroscopic examinations in pediatric radiology departments. VCUG is also considered a follow-up examination after urinary tract surgery, and one of the most sensitive techniques for studying anatomy of the lower genitourinary tract in suspected anatomical malformations. The international reflux study in 1985 published the first reflux-protocol and graded VUR into five classes; over the following years, other papers have been published on this topic. In 2008, the European Society of Paediatric Radiology (ESPR) Uroradiology Task Force published the first proposed VCUG Guidelines with internal scientific society agreement. The purpose of our work is to create a detailed overview of VCUG indications, procedural recommendations, and to provide a structured final report, with the aim of updating the 2008 VCUG paper proposed by the European Society of Paediatric Radiology (ESPR). We have also compared VCUG with contrast-enhanced VUS as an emergent alternative. As a result of this work, the ESPR Urogenital Task Force strongly recommends the use of contrast-enhanced VUS as a non-radiating imaging technique whenever indicated and possible.

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Authors and Affiliations

  1. Pediatric Radiology Department, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy

    Maria Beatrice Damasio

  2. Pediatric Surgery Department, University of Genova, Genoa, Italy

    Francesco Donati

  3. Radiology Department, AOUI Verona (Azienda Ospedaliera Universitaria Integrata), Verona, Italy

    Costanza Bruno

  4. Department of Radiology, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA

    Kassa Darge

  5. Section of Pediatric Radiology, Department of Radiology, Universitätsklinikum Jena, Jena, Germany

    Hans-Joachim Mentzel

  6. Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia

    Damjana Ključevšek

  7. Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children’s Hospital, Milan, Italy

    Marcello Napolitano

  8. Department of Radiology/Division of Pediatric Radiology, Hacettepe University School of Medicine, Ankara, Turkey

    H. Nursun Ozcan

  9. Department of Radiology, Medical University Graz, Graz, Austria

    Michael Riccabona

  10. Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands

    Anne M. Smets

  11. Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy

    Carmelo Sofia

  12. McMaster University and McMaster Children’s Hospital, Hamilton, ON, Canada

    Samuel Stafrace

  13. Department of Pediatric Radiology, Hopital Timone Enfants, Aix Marseille-Université, Marseille, France

    Philippe Petit

  14. Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Oslo, Norway

    Lil-Sofie Ording Müller

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  1. Maria Beatrice Damasio
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All authors contributed to the study conception and design. The first draft of the manuscript was written by MB.D and F.D. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Damasio, M.B., Donati, F., Bruno, C. et al. Update on imaging recommendations in paediatric uroradiology: the European Society of Paediatric Radiology workgroup session on voiding cystourethrography. Pediatr Radiol 54, 606–619 (2024). https://doi.org/10.1007/s00247-024-05883-y

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