INTRODUCTION: One of the common risk factors in urinary tract infection is vesico-ureteral reflux. According to some studies, it is seen in 30%-50% of children and 40%-50% present with febrile urinary tract infection. The presence of moderate to severe reflux is an important risk factor in terms of acute pyelonephritis and reflux nepropathy. Investigation of children with urinary tract infection has undergone change so as to detect those who will benefit from diagnosis and treatment at the same time avoid over investigation.
OBJECTIVE: The present study aimed to determine the role of ureteral jet angle (UJA) in detecting vesicoureteral reflux (VUR) as compared to the gold standard of voiding cystourethrography (VCUG).
METHODS: A total number of 152 kidneys from 76 patients (37 female and 39 males) ages from 2 months up to 11 years old were included in this study. These patients presented with recurrent urinary tract infection as confirmed via routine urinalysis and/or urine culture and sensitivity and assessed to have vesico-ureteral reflux disease as confirmed by voiding cystourethrogram (VCUG). They were included regardless of the grade of reflux (grade I-V). Patients with urinary tract infection but negative VCUG were also included. Excluded from the study were parents with no consent, patients with neurogenic bladder disorder as cause of recurrent urinary tract infection, patients who had postoperative correction of vesico-ureteral reflux prior to ureteral jet angle sonography, patients currently taking medication for urinary tract infection and patients currently symptomatic for recurrent urinary tract infection i.e. fever,chills,dysuria. All of the participants underwent kidney, urinary bladder ultrasound with ureteral jet angle sonography and all data were collected.
RESULTS: Out of 152 kidneys, vesicoureteral reflux was seen in 91 of them (60%). Low grade reflux defined as grade I or grade II reflux was present in 32 kidneys (21%) and high grade reflux defined as grade III-V reflux was seen in 59 kidneys (39%). In both right and left kidneys, no significant difference was observed in bladder volume and expected bladder capacity (EBC) by VUR status. On the other hand, there was a significant difference observed in volume to reach reflux by VUR status of both right and left kidneys. No significant difference was observed in UJA volume, EBC, EBC% and UJA degrees by VUR status in the right kidneys. On the other hand, UJA volume, EBC and EBC% was significantly different by VUR status in the left kidneys. All AUCs were less than 0.7 even if EBC was considered. Therefore, UJA may have poor ability to classify patients correctly according to their VUR status.
CONCLUSION: Doppler flow ultrasound measurement of ureteral jet angle may be a simple and real non invasive test in children of any age but it only showed poor correlation compared to voiding cystourethrography in detecting vesicoureteral reflux. The ureteral jet angle sonography may not be a good initial diagnostic test in assessing vesicoureteral reflux due to its low sensitivity and specificity in detecting the said disease.

Human ; Male ; Female ; Child ; Child Preschool ; Infant ; Dysuria ; Kidney ; Urinalysis ; Urinary Bladder, Neurogenic ; Urinary Tract Infections ; Vesico-ureteral Reflux

OBJECTIVE: MRI-Ultrasound fusion guided targeted biopsy has revolutionized the diagnosis of prostatecancer through accurate identification, localization and characterization of prostatic lesions utilizingthe prostate imaging reporting and data system (PI-RADS) scoring system by multiparametric MRI(MPMRI). The fusion prostate biopsy system on the other hand, enables accurate targeting and easyaccess of the tumor. The study objective is to determine the detection rate of clinically-significantprostate cancer using fusion biopsy, and to establish the correlation between PI-RADS score andGleason's score. PATIENTS AND METHODS: A retrospective cohort study was conducted to determine the correlation betweenPI-RADS score and the presence of prostate cancer using MRI-Ultrasound fusion guided transperinealprostate biopsy. This was carried out from June 2017 to July 2018 in a single institution. One hundredthirty five (135) men were included in this study. They presented with an elevated PSA, abnormalDRE or a previous negative prostate biopsy, but with a persistent rise in PSA. A total of 220 prostatelesions were identified. The following characteristics were measured: patient age; the size, location,the PI-RADS score of each lesion, the maximum PI-RADS score for select patients; and the Gleasonscore of discovered tumors. RESULTS: Two hundred twenty PI-RADS 3, 4 and 5 lesions were detected in 135 patients by MPMRI.131 of the 220 lesions were scored as PI-RADS 3, 61 as PI-RADS 4 and 28 as PI-RADS 5. Theselesions were biopsied using the MRI-Ultrasound fusion guided transperineal prostate biopsy system.Thirty-three out of the 131 PI-RADS 3 lesions (25.2%), 44 out of the 61 PI-RADS 4 lesions (72.1%)and 24 out of the 28 PI-RADS 5 lesions (85.7%) respectively were positive for malignancy. Overall,there were 101 (45.9%) lesions classified as PI-RADS 3 to 5 that were positive for prostate carcinoma.Seventy four (74) of the 135 patients (54.8%) were diagnosed with prostate adenocarcinoma. Nineteenout of 65 patients with a maximum score of PI-RADS 3 (29.2%), 33 of 44 with a maximum of PI-RADS 4 (75%) and 22 of 26 with a maximum of PI-RADS 5 (84.6%) harbored malignancy. In termsof location, 45 of the 101 (44.6%) malignancies were in the peripheral sector, 31 (30.7%) in theanterior sector, and 25 (24.8%) in the central sector of the prostate. The mean Gleason grade of PI-RADS 3, 4 and 5 lesions were 6.61, 7.73, and 7.38, respectively. Using Spearman correlation, the rhocoefficient was 0.3153 (p-value =.00013) which denotes a significant positive relationship betweenGleason and PI-RADS score. CONCLUSION This is the first comprehensive Philippine study on Multiparametric MRI-Ultrasoundfusion-guided transperineal prostate biopsy. Present data validate the superiority of MPMRI in theidentification, localization and characterization of prostate cancers. The authors also verified thepositive correlation between PI-RADS score and Gleason score. Finally, they demonstrated theaccuracy of the MRI- ultrasound fusion-guided transperineal prostate biopsy system in targetingprostate lesions.