The role of hydronephrosis and vesicoureteral reflux in predicting renal scarring in pediatric neurogenic bladder

Year 2025, Volume: 16 Issue: 56, 130 - 136, 16.12.2025

Reyhan Koroglu , Muammer Urhan

https://doi.org/10.17944/interdiscip.1613184

Abstract

Objective: This study aimed to compare the visualization methods used in the follow-up of children diagnosed with neurogenic bladder and to determine which imaging method best predicts renal scarring.
Method: A total of 33 children diagnosed with neurogenic bladder and 64 renal units were retrospectively evaluated. Renal ultrasound (USG), voiding cystourethrogram (VCUG), renal scintigraphy, and urine culture results obtained within 15 days were analyzed. Renal scars detected on the Technetium-99m dimercaptosuccinic acid (Tc-99m-DMSA) scan were accepted as the gold standard. The chi-square test was used to compare the results of VCUG, ultrasound, and Technetium-99m dietilentriaminepentaacetic acid (Tc-99m DTPA). Receiver Operating Characteristic Curve (ROC) analysis was performed to assess the predictive power of hydronephrosis (detected on USG) and vesicoureteral reflux (VUR) (detected on VCUG) in predicting renal scars.
Results: The presence of renal scars on the Tc-99m DMSA scan was found to be 5 times higher in cases with VUR compared to those without (P=0.01, cutoff=2.00; sensitivity=0.50, specificity=0.89, positive predictive value (PPV)=0.58, negative predictive value (NPV)=0.85, area under the receiver operating characteristic curve (AUC)=0.691). The presence of renal scars was 9.3 times higher in patients with hydronephrosis detected by USG compared to those without (P=0.006, cutoff=2.0; sensitivity=0.85, specificity=0.63, PPV=0.41, NPV=0.93, AUC=0.764).
Conclusion: Renal scars must be investigated in children with neurogenic bladder in the presence of both VUR and hydronephrosis, which are the two most important complications. It should also be considered that renal parenchymal damage may occur even in cases with low-grade VUR or hydronephrosis.

Keywords

Neurogenic bladder , vesicoureteral reflux , hydronephrosis , renal scarring , children

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