Skip to main content
SpringerLink
Log in

Reflusso vescico-ureterale

  • Chapter
Mezzi di contrasto in ecografia

  • 378 Accesses

Estratto

Si definisce reflusso vescico-ureterale (RVU) un disordine anatomico e urodinamico che consiste nella risalita dell’urina dalla vescica in uno o entrambi gli ureteri, a causa di un’incontinenza del dispositivo valvolare formato dall’estremità distale dell’uretere e dalla parete vescicale (giunzione vescico-ureterale - GVU). Esso può raggiungere il parenchima renale mediante il reflusso intrarenale generando, in tal modo, danni parenchimali, documentati da cicatrici o scar corticali, e conducendo a complicanze gravi, quali insufficienza renale cronica e ipertensione. Pur essendo solitamente congenito, il RVU può insorgere anche in epoca post-natale e nei pazienti adulti, in particolare in quelli sottoposti a trapianto di rene con neoanastomosi uretero-vescicale. In età pediatrica, il RVU rappresenta l’uropatia più frequente, con un’ incidenza che varia dall’ 1–2% nella popolazione pediatrica generale al 30–40 % nei bambini con infezioni ricorrenti delle vie urinarie (UTI), ed è la prima causa di danno renale nell’infanzia [1]. L’età influenza notevolmente il reflusso, poich’e spesso esso è semplicemente legato all’immaturità del meccanismo sfinteriale.Anche il sesso sembra inoltre influenzare l’incidenza del RVU: l’80% delle diagnosi in epoca neonatale riguarda il sesso maschile e sembra che ciò sia da riferire a più elevate pressioni minzionali; in età infantile tale percentuale può ridursi fino al 20% [2].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 59.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliografia

  1. Jacobson SH, Hansson S, Jacobson B (1999) Vesico-ureteric reflux: occurence and long-term risks. Acta Paediatr [Suppl 88]:22–30

    Article  Google Scholar 

  2. Devriendt K, Fryns JP (1995) Genetic locus on chromosome 6p for multicystic renal displasia, pelvi-ureteral junction stenosis, and vescico-ureteral reflux. Am J Med Genet 59:396–398

    Article  PubMed  CAS  Google Scholar 

  3. Fanos V, Khoory BJ, Vecchini S et al (1998) Il reflusso vescico-ureterale in pediatria. Min Pediatr 50:367–374

    CAS  Google Scholar 

  4. Mackie GG, Awang H, Stephens FD (1975) The ureteric orifice: the embryologic key to radiologic status of duplex kidneys. J Pediatr Surg 10:473–481

    Article  PubMed  CAS  Google Scholar 

  5. Tanagho EA, Pugh RC (1963) The anatomy and function of the ureterovesical junction. Br J Urol 35:151–165

    PubMed  CAS  Google Scholar 

  6. Zerin JM, Ritchey ML, Chang ACH (1993) Incidental vesicoureteral reflux in neonates with antenatally detected hydronephrosis and other renal abnormalities. Radiology 187:157–159

    PubMed  CAS  Google Scholar 

  7. Hinmann F, Bauman FW (1973) Vesical and ureteral damage from voiding dysfunction in boys without neurologic or obstructive desease. J Urol 109:727–732

    Google Scholar 

  8. Jorgensen TM, Mortensen J, Nielsen K et al (1984) Pathogenic factors in vesico-ureteral reflux. Scand J Urol Nephrol 18:43–48

    Article  PubMed  CAS  Google Scholar 

  9. Sillen U (1999) Vesicoureteral reflux in infants. Pediatr Nephrol 13:355–361

    Article  PubMed  CAS  Google Scholar 

  10. Sillen U (1999) Bladder disfunction in children, with vesco-ureteric reflux. Acta pediatr [Suppl 431]:40–47

    Article  Google Scholar 

  11. Holmdahl G (1997) Bladder dysfunction in boys with posterior urethral valves. Scand J Urol Nephrol Suppl 188:1–36

    PubMed  CAS  Google Scholar 

  12. Gordon I (1995) Vesico-ureteric reflux, urinary-tract infection and renal damage in children. Lancet 346:489–490

    Article  PubMed  CAS  Google Scholar 

  13. American Academy of Pediatrics Committee on quality improvement. Subcommittee on urinary tract infections (1999) Practice Parameters; the Diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 103:843–852

    Google Scholar 

  14. Kmetec A, Buturovic-Ponikvar J, Kandus A et al (2001) The value of renal resistive index for the detection of vesicoureteral reflux in renal transplant recipients. Transplant Proc 33:3385–3387

    Article  PubMed  CAS  Google Scholar 

  15. Kmetec A, Kapaln-Pavlovcic S, Kandus A et al (2001) Surgical management of high-grade vesicoureteral reflux in renal transplant recipients. Transplant Proc 33:3383–3384

    Article  PubMed  CAS  Google Scholar 

  16. Coosemans W, Rega F, Roels L et al (1999) Impact of early vesico-ureteral reflux on the transplanted kidney. Transplant Proc 31:362–364

    Article  PubMed  CAS  Google Scholar 

  17. Del Maschio A, Miotto D, Perale R (1979) Homogeneous nephrogram observed during intrarenal reflux. Invest Radiol 14:447–448

    Article  PubMed  Google Scholar 

  18. Kmetec A, Bren AF, Kandus A et al (2001) Contrast-enhanced ultrasound voiding cystography as a screening examination for vesco-ureteral reflux in the follow-up of renal transplant recipients: a new approach. Nephrol Dial Transplant 16:120–123

    Article  PubMed  CAS  Google Scholar 

  19. Mastrosimone S, Pignata G, Maresca MC et al (1993) Clinical significance of vesicoureteral reflux after kidney transplantation. Clin Nephrol 40:38–45

    PubMed  CAS  Google Scholar 

  20. Grunberger T, Gnant M, Sautner T et al (1993) Impact of VUR on graft survival in renal transplantation. Transplant Proc 25:1058–1059

    PubMed  CAS  Google Scholar 

  21. Hellerstein S (1995) Urinary tract infections-old and new concepts. Pediatr Clin North Am 42:1433–1457

    PubMed  CAS  Google Scholar 

  22. Roberts JA (1991) Etiology and pathophysiology of pyelonephritis. Am J Kidney Dis 17:1–9

    PubMed  CAS  Google Scholar 

  23. Scheider K, Kruger-Stollfuss I, Ernst G et al (2001) Paediatric fluoroscopy-a survey of children’s hospital in Europe. I. Staffing, frequency of fluoroscopic procedures and investigation technique. Pediatr Radiol 31:238–246

    Article  Google Scholar 

  24. Lebowitz RL, Olbing H, Parkullainen KV et al (1985) International system of radiographic grading of vescicoureteric reflux. Pediatr Radiol 15:105–109

    Article  PubMed  CAS  Google Scholar 

  25. Darge K (2002) Diagnosis of vescicoureteral reflux with ultrasonography, Pediatr Nephrol 17:52–60

    Article  PubMed  Google Scholar 

  26. Cleveland RH, Constantinou C, Blickman JC et al (1992) Voiding cystourethrography in children: value of digital fluoroscopy in reducing radiation dose, AJR 158:137–142

    PubMed  CAS  Google Scholar 

  27. Valentini AL, Campioni P, Mirk P et al (1994) Diagnostica per immagini nella patologia dell’apparato urogenitale, In: Marano P, Diagnostica per immagini, Casa Editrice Ambrosiana, Milano, pp 1276–1279

    Google Scholar 

  28. Hellstrom M, Jacobsson B(1999) Diagnosis of vescoureteric reflux. Acta Pediatr [Suppl 431]:3–12

    Article  Google Scholar 

  29. Riccipetitoni G, Chierici R, Tamisari L et al (1992) Postnatal ultrasound screening of urinary malformations. J Urol 148:604–605

    PubMed  CAS  Google Scholar 

  30. Blane C, Di Pietro M, Zeri JM et al (1993) Renal sonography is not a reliable screening examination for vesicoureteral reflux. J Urol 150:752–755

    PubMed  CAS  Google Scholar 

  31. Hanbury DC, Coulden RA, Barman P et al (1990) Ultrasound cystography in the diagnosis of vesicoureteric reflux. B J Urol 65:250–253

    Article  CAS  Google Scholar 

  32. Oak S, Kulkarni B, Chaubal N (1999) Color flow doppler sonography: a reliable alternative to voiding cystouretrogram in the diagnosis of vesicoureteral reflux in children. Pediatr Urol 53:1211–1214

    CAS  Google Scholar 

  33. Kuhns LR, Hernandez R, Loff S (1977) Absence of vesico-ureteral reflux in children with ureteral jets. Radiology 124:185–187

    PubMed  CAS  Google Scholar 

  34. Egghart G, Schlickenrieder HJM, Hautman R (1987) Diagnosis of reflux in children with CO2 and ultrasound-preliminary results. Urologe 25:329–332

    Google Scholar 

  35. Kessler RM, Altman DH (1981) Real time sonographic detection of vesicoureteral reflux in children. AJR Am J Roentgenol 138:1033–1036

    Google Scholar 

  36. Schneider K, Jablonski C, Wiessner M et al (1984) Screening for vesicoureteral reflux in children using real-time sonography. Pediatr Radiol 14:400–403

    Article  PubMed  CAS  Google Scholar 

  37. Darge K, Ghods S, Zieger B et al (2001) Reduction in voiding cystourethrographies after the introduction of contrast enhanced sonographic reflux diagnosis. Pediatr Radiol 31:790–795

    Article  PubMed  CAS  Google Scholar 

  38. Atala A, Ellsworth P, Share J et al (1998) Comparison of sonicated albumin enhanced sonography to fluoroscopic and radionuclide voiding cystography for detecting vesicoureteral reflux. J Urol 160:1820–1822

    Article  PubMed  CAS  Google Scholar 

  39. Schlief R, Schuerman R, Niendorf HP (1993) Basic properties and results of clinical trias of ultrsound contrast agents based on galactose. Ann Acad Med 22:762–767

    CAS  Google Scholar 

  40. Mentzel HJ, Vogt S, Petzer L et al (1999) Contrast enhanced sonography of vesicoureteral reflux in children: preliminary results. AJR 173:737–740

    PubMed  CAS  Google Scholar 

  41. Valentini AL, De Gaetano AM, Destito C, et al (2002) The accuracy of voiding urosonography in detecting vesico-ureteral reflux: a summary of existing data. Eur J Pediatr 161:380–384

    Article  PubMed  Google Scholar 

  42. Berrocal FT, Moreno G, Gomez LN et al (2000) Cystosonography with echo-enhancer. A new imaging technique for diagnosis of vesicoureteral reflux objective. Ann Esp Pediatr 53:422–430

    Google Scholar 

  43. Darge K, Troeger J, Duetting T et al (1999) Reflux in young patients: comparison of voiding US of the bladder and retrovesical space with echo enhancement versus voiding cystourethrography for diagnosis. Radiology 210:201–207

    PubMed  CAS  Google Scholar 

  44. Valentini AL, Salvaggio E, Manzoni C et al (2001) Contrast-enhanced gray-scale and color doppler voiding uro-sonography versus voiding cystourethrography in the diagnosis and grading of vesicoureteral reflux. J Clin Ultrasound 29:65–71

    Article  PubMed  CAS  Google Scholar 

  45. Darge K, Bruchelt W, Roessling G et al (2003) Interaction of normal saline solution with ultrasound contrast medium: significant implication for sonographic diagnosis of vesicoureteral reflux. Eur Radiol 13:213–218

    PubMed  Google Scholar 

  46. Valentini AL, De Gaetano AM, Minordi LM et al (2004) Contrast-enhanced voiding US for grading of reflux in adult patients prior to antireflux ureteral implantation. Radiology 233:35–39

    Article  PubMed  Google Scholar 

  47. Gelfand MJ, Strife JL, Hertzberg VS (l991). Low-grade vesicoureteral reflux. Variability in grade on sequential radiographic and nuclear cystograms. Clin Nucl Med 16:243–246

    Article  Google Scholar 

  48. Bosio M, Manzoni GA (2002) Detection of posterior urethral valves with voiding cystourethrosonography with echo contrast. J Urol 168:1711–1715

    Article  PubMed  CAS  Google Scholar 

  49. Matè A, Bargiela A, Mosteiro S et al (2003) Contrast ultrasound of the urethra in children. Eur Radiol 13:1534–1537

    Article  PubMed  Google Scholar 

  50. Ascenti G, Zimbaro G, Mazziotti S et al (2004) Imaging of vesicoureteric reflux in children: usefulness of a second generation US contrast agent. Pediatr Radiol 34:481–487

    Article  PubMed  Google Scholar 

  51. Darge K, Zieger B, Rohrshneider W et al (2001) Contrast-enhanced harmonic imaging for the diagnosis of vesicoureteral reflux in pediatric patients. AJR Am J Roentgenol 177:1411–1415

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Bioimmagini e Scienze Radiologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Policlinico Universitario “A. Gemelli”, Roma

    Anna Lia Valentini & Renata Vitale

Authors
  1. Anna Lia Valentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Renata Vitale
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Unità Clinica Operativa di Radiologia, Dipartimento di Scienze Cliniche, Morfologiche e Tecnologiche, Università di Trieste, Ospedale di Cattinara, Trieste

    Emilio Quaia

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer-Verlag Italia

About this chapter

Cite this chapter

Valentini, A.L., Vitale, R. (2007). Reflusso vescico-ureterale. In: Quaia, E. (eds) Mezzi di contrasto in ecografia. Springer, Milano. https://doi.org/10.1007/978-88-470-0617-1_20

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-0617-1_20

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0616-4

  • Online ISBN: 978-88-470-0617-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation