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.