Contrast-enhanced voiding urosonography - urodynamics in patients with neurogenic bladder dysfunction: a pilot study within pediatric urological practice.

BACKGROUND: The progressive loss of kidney function is a major cause of morbidity and mortality in children with neurogenic bladder dysfunction. A consequent follow-up, including repeated urodynamics combined with detection of vesicoureteral reflux (VUR) is crucial for the individual treatment of the urinary tract. The aim of our study is to investigate whether contrast-enhanced voiding urosonography -urodynamics (ceVUS-UD) can be used in routine urological diagnostics. Due to its radiation-free nature in a more comfortable environment, this would allow the examination to be performed frequently enabling more accurate monitoring of bladder function.

METHODS: Since January 2025, 19 patients with neurogenic bladder dysfunction have undergone simultaneous ceVUS as part of urodynamic follow-up. The children were 11.4 years old on average (9 male, 10 female) and showed one of the following underlying conditions: spina bifida, detrusor hyperactivity after spinal cord injury, caudal regression syndrome, epispadias, infantile cerebral palsy or myotonic dystrophy type 1. Two-thirds of the patients performed self-intermittent catheterization.

RESULTS: CeVUS-UD can be safely performed as part of routine urodynamic testing without interfering with urological measurements. Previously unknown secondary VUR (sVUR) was detected in six patients (31.6%). In one case, a significant decrease of vesical pressure during the occurrence of reflux was observed. For five children, this led to a change in treatment .

CONCLUSIONS: In this study, CeVUS-UD provides a feasible, safe and radiation-free tool for characterizing neurogenic bladder dysfunction. Whether ceVUS-UD can serve as an alternative to video urodynamics (VUD), and whether routine monitoring of sVUR translates into improved long-term kidney outcomes, remains to be established in further studies.