PURPOSE: The American Academy of Pediatrics recently recommended against routine voiding cystourethrograms (VCUGs) in children 2 to 24 months with initial febrile UTI, raising concern for delayed diagnosis and increased risk of UTI-related renal damage from vesicoureteral reflux (VUR).
We assessed factors potentially associated with higher likelihood of abnormal VCUG, including UTI recurrence, which could allow for more judicious test utilization.
METHODS: We retrospectively reviewed all initial VCUGs performed at Children's Hospital of Michigan between January and June, 2010. History of recurrent UTI was ascertained by evidence of two or more prior positive cultures or history of "recurrent UTI" on VCUG requisition. Outcomes assessed included rates of VUR or any urologic abnormality on VCUG.
RESULTS: Two hundred and sixty-two patients met inclusion criteria. VUR was detected in 21.3 %, urologic abnormality including VUR in 27.4 %. Degree of bladder distension, department of referring physician, study indication, positive documented urine culture, and history of recurrent UTI or UTI and other abnormality were all not associated with increased likelihood of VUR or any urologic abnormality on VCUG.
CONCLUSION: VUR and VCUG abnormality are no more likely when performed after recurrent UTI or for UTI plus other abnormality. This reasons against postponing VCUG until after UTI recurrence, as positive findings are no more likely in this setting.
Written by:
Friedman AA, Wolfe-Christensen C, Toffoli A, Hochsztein DE, Elder JS, Lakshmanan Y. Are you the author?
Department of Urology, Henry Ford Hospital, 2799 W. Grand Blvd, K-9 Urology, Detroit, MI 48202, USA.
Reference: Pediatr Surg Int. 2013 Jun;29(6):639-43.
doi: 10.1007/s00383-013-3301-0
PubMed Abstract
PMID: 23535965
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