The formation of the new algorithm for the anomalies diagnosis and malformation of child urinary system

Relevance: Timely and accurate diagnosis of anatomical and functional condition of the kidneys and urinary tract is crucial for prognosis in children with the urinary system malformations. The lack of descriptiveness of sonographic study, excretory urography and voiding cystourethrography in children with uropathies makes it necessary to use high-tech diagnostic radionuclide and tomographic techniques. However the absence of uniform diagnostic algorithm which combines the traditional and modern approaches to the assessment of the anatomical and functional condition of the urinary system obstructs the wide dissemination of these techniques in pediatric urology. The aim of this study was to create an algorithm for diagnosing kidney and urinary tract abnormalities in children using modern X-ray and radionuclide techniques. Materials and Methods: A retrospective analysis of the diagnostic findings of 1,300 children with anomalies and malformations of the urinary system was performed. To evaluate the anatomical and functional condition of the kidneys and urinary tract, static and dynamic renal scintigraphy, indirect radionuclide cystography, voiding cystourethrography, CT urography, CT hybrid scintigraphy and magnetic resonance imaging were performed. Results: It was found that the implementation of a hybrid or MRI study to clarify the anatomical structure of the affected urinary tract was required in 50% of cases, the sensitivity of both methods was 100%. Sensitivity of voiding dynamic renal scintigraphy in the diagnosis of vesicoureteral reflux was 60%, direct radionuclide cystography was 100% sensitive. Conclusions: The proposed algorithm for estimating the anatomical and functional changes in children with urinary system malformations can decrease the radiation dose and reduce the need for catheterization in the case of vesicoureteral reflux diagnosis.