Detection of vesico-ureteric reflux in renal transplant recipients by colour doppler urosonograpy

Abstract

Introduction: In this study, we evaluated the vesico-ureteric reflux (VUR) in renal transplant recipients by using color Doppler urosonography (CDU).Materials and Methods: Among 149 renal transplant recipients, 42 (27 men, 15 women) who accepted to take part were included to the study. The mean age and duration of post-transplant follow-up of the patients were 35.1+/-1.39 years (15-55) and 63.6+/-7.2 months (7-170), respectively. In all patients, ureterovesical anastomosis and antireflux submucosal tunnel were performed with Lich-Gregoir technique without using ureteral stent. Urinary system was assessed in all patients with CDU without any contrast enhancing agent by the same radiologist. During CDU, patients were asked to make Valsalva maneuver when their bladders were full with urine and were evaluated for reflux. The patients' ureteric jets were first investigated in transverse and then in longitudinal plane by observing distal ureteric segment and ureteral orifice. The flows coming towards the transducer were coded red in color while those moving away from the transducer were coded blue in color. During observation of the distal ureteric segment; detection of red color was regarded as reflux. The patients, in whom reflux was detected by CDU, were reassessed by voiding cystouretrography (VCUG).Results: Among 42 patients who underwent CDU, 7 patients (16.7%) were diagnosed to have VUR. In all patients, the diagnosis of CDU detected VUR was confirmed by VCUG. In 4 patients (57.2%) low grade and in 3 patients (42.9%) intermediate grade reflux was found by using CDU. None of the patients had high grade reflux. In 3 patients (42.9%) grade 2, in 3 patients (42.9%) grade 3, in 1 patient (14.2%) grade 4 reflux were observed during evaluation of these patients by VCUG. Since VCUG is an invasive procedure and the patients who were determined not to have VUR by CDU had no urinary tract infection history in the follow-up they did not undergo VCUG.Conclusion: CDU is a non-invasive and effective method for the diagnosis and follow-up of VUR in renal transplant recipients.