Optimizing pediatric vesicoureteral reflux management: a single-center experience with contrast-enhanced ultrasound in reducing radiation exposure and antibiotic use

Abstract Background Vesicoureteral reflux is the most common pediatric urological anomaly and a leading cause of urinary tract infections in children. Traditional follow-up typically relies on voiding cystourethrography, which exposes young patients to ionizing radiation. The introduction of contrast-enhanced ultrasound provides a radiation-free alternative with comparable diagnostic accuracy. This study aims to demonstrate that the use of contrast-enhanced ultrasound can shorten follow-up intervals, thereby reducing the duration of antibiotic prophylaxis. Methods A prospective observational study was conducted between 2019 and 2024, involving 1050 children with urinary tract infections, hydronephrosis, or a known history of vesicoureteral reflux. The cohort included both male and female children, aged between 1 and 15 years. Diagnosis was confirmed using conventional ultrasound and contrast-enhanced ultrasound. Patients with grade III to V vesicoureteral reflux underwent contrast-enhanced voiding urosonography at 12 months, replacing the standard voiding cystourethrography typically performed at 24 months. Clinical data were collected on reflux severity, gender distribution, and changes in antibiotic use. Results Early reassessment using contrast-enhanced voiding urosonography resulted in a significant reduction in the duration of antibiotic prophylaxis. A substantial number of patients showed resolution or downgrading of vesicoureteral reflux at 12 months, allowing for earlier discontinuation of treatment. The diagnostic accuracy of the ultrasound-based approach was consistent across age groups and genders. Conclusions In our single-center experience, the incorporation of contrast-enhanced voiding urosonography into follow-up protocols for pediatric vesicoureteral reflux has been demonstrated to be a safe and effective alternative to traditional imaging. By allowing earlier reassessment without radiation exposure, contrast-enhanced voiding urosonography facilitates the safe discontinuation of prophylactic antibiotics, thereby enhancing patient safety and contributing to the reduction of antibiotic resistance. Trial registration Not applicable. This is an observational study and does not meet the criteria for mandatory trial registration.