الفهرس 
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Abstract
Vesico – ureteral reflux (VUR) is a significant cause of renal damage and the reason of 25% of the end stage renal disease. Prevalence of VUR is 25% below 4 years of age, and 12% between 4 – 12 years.
High-grade VUR is more likely to develop injuries in kidney. Therefore, antibiotic prophylaxis is not recommended in patients with low-grade VUR in the last guidelines, although these children need antibiotic prophylaxis and / or surgical treatment.
Voiding cysto – ureterography (VCUG) is the gold standard diagnostic test that is invasive and carries the risk of radiation exposure which is problem with pediatric cases. VCUG, is not an appropriate diagnostic method in the screening and follow-up of patients due to its high radiation risk and being invasive.
US is a noninvasive examination that is easy to perform and has no radiation, and it is used as a screening method in many centers, especially in the follow-up of urinary tract infection and hydronephrosis. US is recommended by the American Academy of Pediatrics (AAP) as a screening method for predicting the presence of VUR in patients with urinary tract infections.
Aim of the work:
This study was aiming to explore the proper role and indication for the use of ultrasonography (US) in the VUR disease and compare it with the VCUG which is gold standard..
Patients and methods
This study was carried out as a cross-sectional study was conducted to assess the value of ultrasonography (US) in the VUR disease. This study was carried out in radiology department of Benha Hospital of children during the period from 1st January to 31st September 2023.
The study was conducted on 100 UTI children between ages of 0-17, who were referred to the radiology department from the pediatric nephrology department for VCUG imaging due to urinary tract infection and hydronephrosis attending Benha university hospital and the pediatric hospital from January 2023 till September 2023 who fulfill the inclusion criteria and who agree to participant in the study.
Inclusion criteria
• Age 0-17 years.
• Approval to participate in the study
• Suffering from urinary tract infection and hydronephrosis.
Exclusion criteria
• Children with a history of neurogenic bladder, congenital and acquired urogenital anomalies.
• Children with operation due to urinary tract pathology.
• Children without simultaneous US and VCUG examination.
All the included patients were subjected to:
Full history taking including; name age and sex.
Radiological examination:
US examination was performed at least one week before VCUG. For the evaluation of hydronephrosis (Fernbach et al., 1993).
VCUG was performed and according to VCUG findings VUR were classified 0 to 5 according to the International Reflux Study Classification. Grade 1, 2, and 3 VUR were accepted as low-grade reflux, whereas Grade 4 and 5 VUR were accepted as high-grade reflux (Lebowitz et al., 1985).
By analyzing and processing the data obtained from the history and evaluation, our study declared that:
• US was able to detect 78 % of cases and 22% of patients diagnosed to have VUR in ascending VCUG were not detected with ulrasonography.
• On assessing the relationships between High-Grade VUR and Renal US Criteria it was found that; increased renal size, increased echogenicity, dilated ureter, ureteral wall thickening, prominent renal pelvis and pelvic wall thickening were all significantly increased among VUR Grade ≥ 3 than VUR Grade < 3.
• The percentage of increased renal size, increased echogenicity, dilated ureter, ureteral wall thickening, prominent renal pelvis and pelvic wall thickening were significantly increased among high grade VUR than low grade VUR.
• On analyzing the sensitivity of Ultrasonography for diagnosing VUR, the current study revealed that US on diagnosing degre1 VUR, degree 2 VUR, degree 3 VUR, degree 4VUR and degree 5VUR were; 44.4%, 61.5%, 93.3%, 100% and 100%, respectively
• ROC curve to show the diagnostic ability of ultrasound, we found that the area under ROC curve for US in differentiating VUR cases was 0.874 with a sensitivity of 78.5% and a specificity of 100% yielding total accuracy of 80%.
Conclusion