소아의 방광요관역류에대한 방사성동위원소 방광촬영술 : Evaluation with Radionuclide Cystography

김미성 關東大學校 醫科大學 醫科學硏究所 2002 關東醫大學術誌 Vol.6 No.1

The purpose of this study was to assess the diagnostic value and role of radionuclide cystography for the evaluation of vesicoureteral reflux in children with tract infection. Forty one consecutive children with urinary tract infection(age range 3 months-14 years; 25 boys and16(girls) were included in the study. There are 23 children studied with direct radionuclide cystography, and ^99mTc-DMSA scintigraphy in the detection and evaluation of serial change of vesicoureteral reflux. Eighteen patients had no vesicoureteral reflux on both voiding cystourethrography and direct radionuclide cystography, 5 patients had vesicoureteral reflux(2 cases of grade Ⅰ, 1 case of grade Ⅱ, and 2 cased of grade Ⅲ)on direct radionuclide cystrography, not on voiding cystourethrogrpahy; in 3 of 5 patients parenchymal lesions are also detected on ^99mTc-DMSA scintigraphy. On follow-up radionuclide cystography for known vesicoureteral reflux in 18 patients, 24 of the 28 vesicoureteral reflux changed in degree of vesicoureteral reflux; of theses 21 cases aggravated and 3 cases improved, and 4 cases of vesicoureteral reflux were not change. In conclusion radionuclide cystography is more sensitive than voiding cystourethrography in the detection of vesicoureteral reflux in children with urinary tract infection and recommented as a useful modality of choice for observing known vesicoureteral reflux.

Are Clinical, Laboratory, and Imaging Markers Suitable Predictors of Vesicoureteral Reflux in Children With Their First Febrile Urinary Tract Infection?

Abolfazl Mahyar,Parviz Ayazi,Shiva Mavadati,Sonia Oveisi,Morteza Habibi,Shiva Esmaeily 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.8

Purpose: This study was conducted to determine the predictive value of clinical, laboratory,and imaging variables for the diagnosis of vesicoureteral reflux in children withtheir first febrile urinary tract infection. Materials and Methods: One hundred fifty-three children with their first febrile urinarytract infection were divided into two groups according to the results of voiding cystourethrography:60 children with vesicoureteral reflux and 93 children without. Thesensitivity, specificity, positive and negative predictive value, likelihood ratio (positiveand negative), and accuracy of the clinical, laboratory, and imaging variables for thediagnosis of vesicoureteral reflux were determined. Results: Of the 153 children with febrile urinary tract infection, 60 patients (39.2%)had vesicoureteral reflux. There were significant differences between the two groupsregarding fever>38oC, suprapubic pain, C-reactive protein quantitative level, numberof red blood cells in the urine, and results of renal ultrasound and dimercaptosuccinicacid renal scanning (p<0.05). There were significant positive correlations between fever>38.2oC and dimercaptosuccinic acid renal scanning and vesicoureteral reflux. Also, there were significant positive correlations between the erythrocyte sedimentationrate, positive urinary nitrite test, hyaline cast, and renal ultrasound andhigh-grade vesicoureteral reflux. Conclusions: This study revealed fever>38.2oC and dimercaptosuccinic acid renalscanning as the best predictive markers for vesicoureteral reflux in children with theirfirst febrile urinary tract infection. In addition, erythrocyte sedimentation rate, positiveurinary nitrite test, hyaline cast, and renal ultrasound are the best predictivemarkers for high-grade vesicoureteral reflux.

Long-term Outcomes of Endoscopic Anti-reflux Surgery in Pediatric Patients with Vesicoureteral Reflux: Urinary Tract Infection, Renal Scarring, and Predictive Factors for Success

최원석,남욱,이찬우,한재현,신정현,김건석,송상훈 대한의학회 2018 Journal of Korean medical science Vol.33 No.38

Background: To report the long-term outcomes of endoscopic surgery (ES) in pediatric patients with vesicoureteral reflux in terms of success rate, urinary tract infection, and renal function. Methods: We retrospectively reviewed the records of 73 pediatric patients (110 ureters) who underwent ES for vesicoureteral reflux. Ultrasonography was performed 1, 3, and 12 months postoperatively. Voiding cystourethrography was performed 3 months postoperatively and repeated after 1 year if vesicoureteral reflux persisted. Success was defined as the absence of reflux at the first voiding cystourethrography. Renal scans were performed at least 12 months postoperatively. Renal function deterioration was defined as a new scar or a greater than 5% decrease in function. Results: The median follow-up duration was 24 (12–118) months. The overall success was 65.6%, while it was 78.9%, 87.0%, 62.5%, 37.5%, 66.7% for grades I, II, III, IV, and V, respectively. In multivariate analyses, significant predictive factors for success were vesicoureteral reflux grade (odds ratio [OR], 0.28; P < 0.001) and mound detection at the first postoperative ultrasonography (OR, 13.53; P < 0.001). Renal function deterioration was found in 8 (15.3%) ureters and was less common in those with successful surgeries than in those with failures (9.5% vs. 40.0%; P = 0.035). No significant predictive factor for renal function deterioration or urinary tract infection was found. Conclusion: Successful short-term outcomes of ES are expected in low-grade vesicoureteral reflux, especially when a mound is detected by postoperative ultrasonography. However, unpredictable long-term renal deterioration warrants continued follow-up.

신반흔을 동반한 역류성 신병증의 임상적 특징 및 치료효과에 관한 연구

이종국,정진섭,박용원 인제대학교 1993 仁濟醫學 Vol.14 No.2

소아 고혈압과 만성신부전증의 주요 원인이 되고 있는 역류성 신병증 환아 35명의 임상적특징 및 치료효과를 관찰한 결과 6명(17%)이 만성신부전증으로 진행되었고 항생제 예방요법과 수술받은 환아들을 비교한 결과 적어도 요로감염증 발생빈도에 있어서는 의미있는 차이가 없었다. 항생제 예방요법을 받은 환아들 중 방광요관역류가 관찰된 20개의 요관중 5개(25%)에서 역류의 자연소실이 일어났다. At the Seoul Paik Hospital of Inje University during the 6 years period 1986 through 1992, reflux nephropathy was diagnosed in 35 patients. We have studied clinical characteristics of patients with reflux nephropathy and effects of therapeutic modalities on it. 1.The incidence of vesicoureteral reflux among patients less than 1 year of age was 3 times greater in boys than girls but 1.6 times more often in girls after 1 year of age. 2.Urinary tract infection was the most common cause for the evaluation of urinary tract by radiology, which accounted for 71.4%. Asymptomatic proteinuria was 14.3%. Other reasons included enuresis, growth retardation and CRF, fever of unknown origin, prenatal hydronephrosis and nephrotic syndrome with renal insufficiency. 3.E. coli was the most frequent organism isolated from patients with vesicoureteral reflux and urinary tract infection, which accounted for 80%. 4.85% of refluxed kidneys have already had renal scar on diagnosis and 13.2% of kidneys with scarring showed no reflux. 5.The severity of renal scar seemed to be related with the degree of vesicoureteral reflux. 6.6 patients(17%) among total 35 patients progressed to chronic renal failure and their prominent clinical feature was massive proteinuria. 7.There was no significant differance between chemoprophylaxis group and operation group in terms of recurrance of urinary tract infection. It was 41% and 37.5% respectively. 8.2(16.7%) of 12 patients who were on chemoprophylaxis showed no reflux in one to four year period. 9.Reflux was abolished in 10(90.9%) among 11 patients who underwent ureters reimplanted. There were no severe complications after operation. Degree of reflux improved from grade III to grade I in remaining 1 patient.

방광요관역류를 동반한 요로감염증 환아의 추적 관찰

길도환,이재은,김완섭 예수병원 1998 예수병원학술지 Vol.19 No.-

요로감염 환아에서 비방사선학적 방법에 의한 방광요관역류의 조기 예측에 관한 연구

전성회,이광철,유기환,Jeon Seong-Hoi,Lee K.C.,Yoo Kee-Hwan 대한소아신장학회 1997 Childhood kidney diseases Vol.1 No.1

목적 : 방광 요관 역류는 소아에서 반복적인 요로감염을 일으키며 역류성 신병증으로 진행하는 질환으로 복부 초음파, DMSA scanning, 배뇨성 요도 방광 조영술등으로 확진할 수 있으나 이런 방사선학적 검사는 관혈적 방법으로 환아에게 동통 및 불쾌감과 합병증이 발생할 수 있고 검사 시행에 시간이 필요한 단점이 있다. 이에 저자들은 내원 당시 환아의 임상 증상과 혈액 및 뇨의 생화학 검사 소견을 이용하여 방광요관 역류의 가능성을 조기에 예측할 수 있는지 알아 보고자 본연구를 시행하였다. 방법 : 1993년 7월부터 1994년 6월까지 요로감염증으로 고대병원 소아과에 내원한 환아중 방광요관 역류가 있는 24명(A군)과 대조군으로 방광요관 역류를 동반하지 않은 요로감염증 환아 16명(B군)을 대상으로 내원당시의 발열, 혈뇨 및 단백뇨의 유무, C-반응 단백, 혈중 요소질소, 크레아티닌, $^{99m}Tc-DTPA$로 측정한 사구체 여과율, 요중${\beta}_2$-microglobulin, 24시간 뇨중 알부민 양등을 측정 비교하였다. 결과 : 1) 방광 요관역류는 편측성이 14례, 양측성이 10례였으며 International Reflux Study Committee 분류법상, 역류를 보인 34신장중에 Grade I이 3신, Grade II 9신, Grade III 11신, Grade IV 11신의 분 를 보였고 Smellie등에 의한 분류상, 신반흔이 있던 14례중 type A 5례, type B 5례, type C 4례였고 type D는 없었다. 2) A군과 B군간의 평균 사구체 여과율, 혈중 요소질소, 크레아티닌, 24시간 뇨중 알부민의 양과 혈뇨, 단백뇨의 유무 비교는 통계적 의의가 없었다. 3) 요중 ${\beta}_2$-microglobulin의 평균값은 A군이 $283.6{\pm}195.8{\mu}g/l$, B군이 $78.7{\pm}48.5{\mu}g/l$로 방광요관 역류가 있는 경우가 의미있게 높았다 (p<0.01). 4) 요중 ${\beta}_2$-microglobulin이 $120{\mu}g/l$이상이면서 내원당시 C-반응 단백이 양성인 경우 민감도 93.3%, 특이도 77.8%(p<0.01)로, 또 요중 ${\beta}_2$-microglobulin이 $120{\mu}g/l$ 이상이면서 발열이 있었던 경우 민감도 92.2%, 특이도 62.5%(p<0.01)로 방광요관 역류가 동반되었다. 결 론 : 요로감염증으로 내원한 환아가 내원당시 발열이 있거나 C-반응 단백이 양성이면서 요중 ${\beta}_2$-microglobulin이 $120{\mu}g/l$ 이상인 경우 방광요관 역류가 존재함을 예측할 수 있어 임상적으로 유용한 지표가 될 수 있을 것으로 사료된다. Purpose : Vesicoureteral reflux(VUR) in childhood may be the primary cause of recurrent urinary tract infection and renal scarring. Renal ultrasonography, DMSA, and voiding cystourethrogram are the standard clinical methods for detection of vesicoureteral reflux. But these methods have many disadvantages such as invasiveness and high cost. So, we studied to observe the significance of urine ${\beta}_2$-microglobulin in association with other non-radiologic methods for predictng vesicoureteral reflux. Methods : We evaluated 40 patients with urinary tract infection who were admitted to Korea university Hospital from July 1993 to June 1994. Among them, 24 patients revealed urinary tract infection and vesicoureteral reflux(group A), 16 patients revealed only urinary tract infection(group B). Both groups were compared by presence of fever, hematuria, and proteinuria, positivity of CRP, and level of BUN, Cr, GFR by 99mTc-DTPA, urine ${\beta}_2$-microglobulin, 24 hours urine albumin. Results : 1) Among 24 patients who had vesicoureteral reflux, 14 had unilateral VUR, 10 had bilateral VUR, three kidneys with grade I, nine with grade II, eleven with grade III, eleven with grade IV by classification of International Reflux Study Committee. Among them, 14 patients had renal scar, five with type A, five with type B, four with type C, none with type D by Smellie's classification. 2) The mean of GFR, BUN, Cr, 24hrs urine albumin and the presence of hematuria and proteinuria showed no significant difference between group A and group B. The mean of urine ${\beta}_2$ microglobulin in group A and group B were $283.6{\pm}195.8{\mu}g/l$ and $78.7{\pm}48.5{\mu}g/l$ respectively, showing that group A had a higher value than group B (p<0.01). In case of ${\beta}_2$ microglobulin > $120{\mu}g/l$ and CRP(+), the sensitivity was 93.3% and the specificity is 77.8% for detecting of VUR. In case of ${\beta}_2$-microglobulin>$120{\mu}g/l$ and fever(+), the sensitivity was 92.2%, and the specificity was 62.5% for detecting of VUR Conclusions : If the level of urinary ${\beta}_2$-microglobulin is more than 120ug/l in children with urinary tract infection in association with fever(+) or CRP(+), it can predict VUR. So we can use it for early detection of VUR.

방광요관역류 치료에서 요관밑이물질 주입술의 발달

최황,백민기 대한의사협회 2008 대한의사협회지 Vol.51 No.11

Vesicoureteral reflux (VUR) is a common cause of urinary tract infection in children. The primary goals of managing VUR are to prevent pyelonephritis, renal damage, and long-term complications. Management may be either medical or surgical. The rationale of medical therapy is that spontaneous resolution of reflux often occurs with time. Surgical therapy is based on the principle that eliminating the reflux will minimize the likelihood of renal damage and other reflux related complications. Open ureteral reimplantation is 95~98% effective for correcting reflux, and has been the standard surgical treatment for many years. In recent years, the management of VUR has changed dramatically, mostly because of the widespread acceptance of endoscopic treatment. Optimal materials for endoscopic treatment need to be easy to inject, nontoxic, and not to migrate to other organs, result in minimal local inflammation, and be well encapsulated. Since the first clinical application of endoscopic treatment for VUR in 1984 employed subureteric polytetrafluoroethylene injection, the materials and techniques have improved considerably. Following the approval of dextranomer/hyaluronic acid by the U.S. Food and Drug Administration in 2001, the endoscopic treatment of VUR has become increasingly popular in many parts of the world. The combination of increased success, minimal morbidity, a reasonable safety profile, and short operative time has strengthened the role of endoscopic treatment for VUR. The long-term durability and reproducibility of results will make endoscopic treatment an effective alternative to antibiotic prophylaxis in low-grade reflux and to open surgery in high-grade reflux.

요로감염 환아에서 신실질내 역류의 임상적 의의

임범택,이해상,배기수,Lim, Beom-Taek,Lee, Hae-Sang,Pai, Ki-Soo 대한소아신장학회 2008 Childhood kidney diseases Vol.12 No.2

목 적 : 신실질내 역류란 소변이 신우에서 신세뇨관으로 역류하는 것을 의미하며 소아에서 신손상을 초래하여 신반흔, 고혈압, 단백뇨, 만성신부전등을 일으킨다. 본 연구의 목적은 방관 요관 역류가 있으면서 신실질내 역류가 있는 환아군과 신실질내 역류가 없는 환아군을 비교 분석하여 신실질내 역류의 임상적 특성에 대하여 알아 보고자 한다. 방 법: 2004년부터 2006년까지 요로감염으로 아주대병원 소아과에 내원한 환아중 배뇨성 방광 요관조영술을 시행하여 3단계 이상의 방광요관역류가 있었던 환아 80명을 대상으로 후향적으로 조사하였다. 환자는 신실질내 역류의 유무에 따라 두 군으로 분류하여 신실질내 역류에 영향을 미치는 요인에 대해 비교 조사하였다. 결 과: 3단계 이상의 방광요관 역류가 있는 환아 80명중 17명이 신실질내 역류가 있는 것으로 조사되었으며 신실질내 역류가 있는 군에서 진단 당시 나이, 역류등급, 단백뇨에서 유의한 차이를 보였으나 성별, 추적검사에서 호전율, 말초혈액 백혈구수, C-반응단백, 요중 백혈구 수, 농뇨 지속기간에서는 유의한 차이를 보이지 않았다. 또한 신실질내 역류의 위치와 DMSA 스캔의 광자 결손의 위치가 대부분에서(82.35%) 일치하는 결과를 나타내었다. 결 론: 방광요관역류에 의하여 발생된 요로감염 환자에서 신실질내 역류가 있는 경우 나이가 적었으며, 방광요관역류의 정도가 심하고, 단백뇨가 많이 검출되었다. 또한 신스캔상 신손상의 빈도가 높은 경향을 보였으나 통계적으로는 유의하지 않았다. 한편 추적영상검사를 하였을 때, 신실질내 역류에 관계없이 대다수 환아에서 진단당시 보였던 방광요관역류나 신손상 소견이 대부분 호전됨을 확인할 수 있었다. Purpose : Intrarenal reflux(IRR) is backflow of urine from the renal pelvis into the collecting ducts. IRR is the main cause of renal injury in children with vesicoureteral reflux (VUR) which leads to renal scars, hypertension, proteinuria, and chronic renal failure. The purpose of our study was to investigate the characteristics of intrarenal reflux. Method : We retrospectively reviewed the medical records of 80 patients who were diagnosed as having grades of III-V VUR from Jan. 2004 to Dec. 2006 in the department of pediatrics in Ajou University Hospital. The patients were divided into two groups according to the presence of IRR on voiding cystoureterogram and compared to each other for the possible factors associated with intrarenal reflux. Results : Among 80 VUR patients, IRR(+) group comprised 17(21.3%) patients and 27 renal units(23.2%) and revealed younger age, higher grade of VUR, and more proteinuria compared to IRR(-) group. There were no significant difference in gender, laboratory findings and the rate of resolution in VUR or defects on renal scan between two groups. Also, intrarenal reflux mostly corresponded to the same site of photon defects on DMSA scan. Conclusion : We suggest that intrarenal reflux tends to be associated with younger age, higher grade of reflux, more proteinuria with no difference in resolution rate of VUR when compared to the VUR patients without IRR. From this study, we were able to understand the characteristics of intrarenal reflux in children with urinary tract infection.

일측성 신발생이상 환아에 동반된 반대측 방광요관역류

오성욱,이재승,김명준,한상원,배기수,Oh Sung-Wook,Lee Jae-Seung,Kim Myoung-Jun,Han Sang-Won,Bae Ki-Soo 대한소아신장학회 1997 Childhood kidney diseases Vol.1 No.1

목적 : 한쪽 신장이 완전히 기능이 없는 무형성신이나 거의 기능이 없는 다낭성이형성신 환아에서 하나 남은 신장마저 방광요관역류가 동반되어 손상되는 사례가 최근 많이 보고되고 있어 일측성 무형성신, 저형성신, 다낭성이형성신을 일측성 신발생 이상이라는 하나의 군으로 묶어 일측성 신발생 이상 반대측으로 방광요관역류가 잘 동반되는지를 조사하고자 하였다. 방법 : 1987년 1월 1일부터 1996년 12월 31일까지 세브란스 병원, 영동 세브란스 병원에서, 또 1994년 1월1일부터 1996년 12월 31일까지 아주대학 병원에서 일측성 무형성신, 저형성신, 다낭성이형성신으로 진단받은 96명의 소아를 대상으로 후향적 연구를 시행하였다. 진단은 방사선 소견에 근거하였으며, 96명의 대상 환아 중 48명의 환아가 배뇨성 방광요도조영술을 시행하였다. 결과 : 1. 일측성 신발생 이상을 가진 96명 환아군의 성별 분포는 남아가 58명으로 60%였고, 여아가 38명으로 40%였다. 2. 일측성 신발생 이상의 분포는 좌측이 45례로 47%였고, 우측이 51례로 53%였다. 3. 일측성 신발생 이상을 진단받게 된 동기를 보면 총 96례 중 산전 진단에 의한 경우가 41례로 가장 많았으며, 요로 감염의 검사 도중이나 다른 동반 기형의 평가 도중 발견된 경우가 각각 18례, 16례로 많았다. 질환별로 볼 때 일측성 무형성신이나 저형성신은 요로 감염의 검사 도중이나 다른 동반 기형의 평가 도중 발견된 경우가 많았으나 다낭성이형성신은 산전 진단으로 발견된 경우가 대부분이었다. 4. 배뇨성 방광요도조영술을 시행한 환아들의 경우 일측성 신발생 이상의 진단 연령은 $1.8{\pm}3.3$세였고, 배뇨성방광요도 조영술의 시행 연령은 $2.5{\pm}3.8$세로 통계적으로 유의한 격차가 있었다(P<0.01). 5. 일측성 무형성신으로 진단받은 18명의 환아 중 9명, 일측성 저형성신으로 진단받은 11명의 환아 중 5명, 일측성 다낭성이형성신으로 진단받은 19명의 환아 중 3명에서 반대측 방광요관역류가 있었다. 6. 방광요관역류가 있었던 환아들은 역류의 정도가 평균 3등급 이상으로 중등도 이상이었다. 반대측 방광요관역류가 있었던 17명의 환아 중 3명은 만성 신부전 상태에 있었고, 6명은 방광요관문합술을 시행받았다. 결론 :한쪽 신장의 기능이 없거나 거의 없다고 여겨지는 일측성 신발생 이상 환아에서 반대측 방광요관역류를 조기에 발견하기위해 선별적 검사로 배뇨성 방광요도조영술을 반드시 시행해야 한다고 결론지을 수 있었다. There have been many recent reports that unilateral renal agenesis and multicystic dysplastic kidneys are accompanied by contralateral vesicoureteral reflux leading to its injury. We grouped the children with unilateral renal agenesis, renal hypoplasia, multicystic dysplastic kidney into abnormal unilateral renal development and investigated whether it was accompanied with contralateral vesicoureteral reflux. We retrospectively reviewed 96 pediatric cases of unilateral renal agenesis, hypoplasia, multicystic dysplastic kidney diagnosed at Shinchon Severance Hospital, Yongdong Severance Hospital from 1987 to 1996 and Ajou University Hospital from 1994 to 1996. Diagnosis was based on radiological findings, renal hypoplasia being defined as small renal size with no apparent renal scarring and no irregularity of the calyceopelvic system on abdominal sonography or intravenous pyelography. Among the 96 cases,48 cases carried out voiding cystourethrography. 58 cases were male(60%) and 38 cases were female(40%). The cases of abnormal unilateral development on the left side were 45(47%) and that on the right side were 51(53%). Although there were diverse reasons leading to diagnosis, the major ones included were prenatal sonography, urinary tract infection, and other congenital anomalies. In cases of unilateral renal agenesis & hypoplasia the leading factors were urinary tract infection & other congenital anomalies and in cases of multicystic dysplastic kidney that was prenatal sonography. There was a chronological gap between the mean age of diagnosis(1.8 year) and voiding cystouerthrography(2.5 year, P < 0.01). 9 of the 18 unilateral renal agenesis cases, 5 of the 11 unilateral renal hypoplasia cases, and 3 of the 19 unilateral multicystic dysplastic kidney cases showed contralateral vesicoureteral reflux. Average reflux grade was above G III.Among the 17 children who had contralateral vesicoureteral reflux, 3 children had chronic renal failure and ureteroneocystostomy was carried out in 6 children. From the above results we conclude that screening voiding cystourethrography should be performed in children with abnormal unilateral renal development for early detection of vesicoureteral reflux in the contralateral kidney.

Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux: a comparison of diagnostic performance with fluoroscopic voiding cystourethrography

Kim Daehee,최영훈,Choi Gayoung,Lee Seul Bi,이승현,조연진,Lim Seon Hee,강희경,천정은 대한초음파의학회 2021 ULTRASONOGRAPHY Vol.40 No.4

Purpose: This study evaluated the diagnostic performance of contrast-enhanced voiding urosonography (ce-VUS) using a second-generation ultrasound contrast agent for the diagnosis of vesicoureteral reflux (VUR) and intrarenal reflux (IRR), and compared it with that of standard fluoroscopic voiding cystourethrography (VCUG). Methods: Thirty-two consecutive children from April to October 2019 were included in this study. ce-VUS and VCUG were performed simultaneously by two operators with intravesical infusion of a mixture of ultrasound contrast medium, iodinated contrast medium and water. Two pediatric radiologists independently reviewed the ce-VUS and VCUG images and reported the presence and degree of VUR (grades I-V), and the presence and type of IRR. Results: Twenty-seven of 63 urinary systems showed VUR. Interobserver agreement for VUR grading was very good for both examinations (κ=0.87; 95% confidence interval [CI], 0.82 to 0.92 for ce-VUS and κ=0.92; 95% CI, 0.87 to 0.96 for VCUG). The detection rate of VUR showed no significant difference between the two examinations (P=0.370). Four cases of VUR were missed on ce-VUS, while one case of VUR was missed on VCUG. All four false-negative cases on ce-VUS were grade 1 VUR. The two examinations showed very good agreement regarding VUR grading (κ =0.89; 95% CI, 0.81 to 0.96). IRR was more frequently detected with ce-VUS than with VCUG (10 cases with ce-VUS vs. 3 cases with VCUG, P=0.016). Conclusion: ce-VUS showed very good agreement with VCUG for detecting grade 2 VUR and above, while grade 1 VUR was sometimes missed with ce-VUS. IRR was more frequently detected with ce-VUS than with VCUG.