Urosound. In-office ultrasonography for pediatric urology

Ultrasound has proved to be very accurate in evaluating children with common urologic problems such as renal obstruction and urinary infection and in screening for uropathology among children with siblings known to have urologic disease. The benefits of ultrasound in a pediatric population include diagnostic accuracy, ease of use, absence of radiation exposure, and no risk of adverse reactions to contrast agents. As a consequence, ultrasound has become routine in the evaluation of children with urologic conditions, and its use has been expanded to screening of healthy infants for urinary tract abnormalities. One (1.3 per cent) of 73 otherwise-healthy babies studied had urologic problems severe enough to warrant surgery. Steinhart and associates recommended the routine use of ultrasound in healthy infants, because a significant number of infants harbor silent urinary tract abnormalities that can be detected by ultrasound at a low cost. Obstetricians and other primary-care physicians as well as urologists have incorporated the office use of ultrasound into the care for their patients and thus avoid the inconvenience and difficulties of outside referral. In addition, the clinician as a sonographer occupies a unique position that permits sonographic information to be related directly to the clinical problem. In this review, we have included more than three times the number of patients studied in the initial report. The ease and accuracy of office ultrasound that we described initially have been confirmed by subsequent experience. The urosound examination is indicated for the initial evaluation of patients with voiding symptoms, urine infection, or hematuria, as well as to screen patients with known congenital anomalies, such as hypospadias. Urosound can be employed in the surveillance of children with dysfunctional voiding to measure the completeness of bladder emptying and hydronephrosis. The degree of hydronephrosis in cases of ureteropelvic junction obstruction, megaureters, ectopic ureters, and ureteroceles and that remaining after surgery may be documented by urosound examination. We have found that when the urosound study is abnormal, further diagnostic evaluation is more efficiently planned. Office-based pediatric urologist-operated ultrasound supplements the information, laboratory studies, and other radiologic investigations.