Does urinary tract ultrasonography at hospitalization for acute pyelonephritis predict vesicoureteral reflux?

PURPOSE: We evaluate the correlation between urinary tract ultrasound during hospitalization for acute pyelonephritis with subsequent voiding cystourethrography in children. MATERIALS AND METHODS: Medical records were reviewed of 184 children up to 18 years old who were evaluated with ultrasound during hospitalization for acute pyelonephritis between January 1988 and January 1996. Followup voiding cystourethrography results were compared to the initial ultrasound findings. RESULTS: Ultrasound was performed at mean hospital day 2.1 and voiding cystourethrography was done 39 days later. Of the ultrasound studies 77 (42%) were abnormal, and two-thirds of these abnormalities were upper tract dilatation. Subsequent voiding cystourethrography was performed in 76% of the study population, including 67% of those with normal and 87% of those with abnormal ultrasound. Voiding cystourethrography revealed reflux in 39% of children with upper tract dilatation compared to 35% of those with normal and 36% with abnormal ultrasound for any reason. In addition, the severity of reflux on voiding cystourethrography could not be predicted by ultrasound findings. CONCLUSIONS: Ultrasound findings during acute pyelonephritis do not correlate with and are not predictive of the presence or grade of vesicoureteral reflux on subsequent voiding cystourethrography.

Bladder cancer: natural history, tumor markers, and early detection strategies.

Transitional cell bladder carcinoma is characterized by a dichotomous, multichronotopic natural history. Low and moderate grade Ta lesions frequently recur, yet rarely invade, and carry an excellent prognosis with currently available treatments. High grade Ta lesions, tumors with lamina propria invasion (T1), and carcinoma in situ often progress to invasive disease, at which time overall prognosis is significantly decreased, despite various treatment alternatives. Although early detection of bladder tumors, prior to muscle invasion, should vastly improve our ability to save both bladders and lives, current methods of detection are neither sufficiently sensitive nor specific. Tumor marker analysis is an exciting new frontier in bladder cancer evaluation, and may have important applications to early detection strategies, in combination with simple hematuria testing and other selected noninvasive screening methods.