Yousefifard M, Toloui A, Alavi SNR, et al. - Diagnostic value of contrast-enhanced voiding urosonography (ceVUS) for vesicoureteral reflux (VUR) falls in an excellent range, with both first-generation and second-generation contrast agents.

• A meta-analysis of data of 36 articles (2768 children) identified from Medline, Embase, Scopus and Web of Science databases, to evaluate the diagnostic value of ceVUS in VUR.

• ceVUS with the first-generation contrast agent offered area under the curve (AUC), sensitivity and specificity of 0.97, 0.92 and 0.94, respectively, for detecting VUR in children and adolescents.

• ceVUS with the second-generation contrast agent afforded an AUC, sensitivity and specificity of 0.97, 0.93 and 0.91.

• Although it appeared that ceVUS could be employed as a radiation-free alternative to imaging methods such as VCUG, there were 3% of false negatives in this test, which is a limitation.

• The lack of punctual management of VUR is related to grave renal complications in children, thus, assessment of the Benefit-risk evaluation of ceVUS in future studies is advised.