New noninvasive methods to diagnose vesicoureteral reflux.

PURPOSE OF REVIEW: The undesirable nature of bladder imaging in children for vesicoureteral reflux detection makes the search for noninvasive bladder imaging methods and devices an urgent concern.

RECENT FINDINGS: Ultrasound imaging of the bladder aided by contrast agents can be performed without ionizing radiation. However, urethral catheterization and contrast instillation is still necessary. The accuracy and reliability are still significant problems with this method. A new method of 'hiding' gadolinium in lysosomes followed by external energy application to rupture the lysosomes releasing the gadolinium for MRI holds future hope, but this research is in its infancy. A novel method to apply external microwave energy to warm the bladder urine with microwave kidney temperature monitoring is being developed. Temperature changes noted in the kidney after bladder warming would indicate vesicoureteral reflux. Further studies are ongoing.

SUMMARY: Ultrasonography imaging of the bladder to find vesicoureteral reflux has yet to be refined enough to be accurate and reliable for clinical use. MRI studies are in their infancy but may hold future benefit. Noninvasive bladder heating and kidney temperature monitoring is showing promise in animal studies to be a completely noninvasive reflux detection device.