Pediatric UrologyIs VCUG Still Indicated Following the First Episode of Urinary Tract Infection in Boys?
Section snippets
Material and Methods
With the approval of our Institutional Review Board, we retrospectively reviewed the records of all boys younger than 10 years of age who underwent RBUS and VCUG at our institution, after the first episode of symptomatic UTI. This cohort includes predominantly boys who were referred by pediatricians after treatment for imaging at our institution. Only an opinion was sought for most of these, by the treating pediatrician, and some were evaluated by our division. All boys who underwent RBUS and
Results
Of the 88 boys who underwent both RBUS and VCUG after the first episode of UTI, 77 satisfied the inclusion criteria. Of the 11 who were excluded, 6 had known pathology before imaging, 2 had antenatal hydronephrosis, and 3 had neurovesical dysfunction. Fifty-eight (77%) were younger than 1 year old. In all, RBUS was normal in 51 (Fig. 1). In 45 boys (58%) both RBUS and VCUG were normal. Of the remaining 32, both studies were abnormal in 16 (21%): All of these had varying degrees of upper tract
Comment
Although the AAP guidelines for febrile UTIs in 1999 for children from 2 months to 2 years of age recommended RBUS and either VCUG or radionuclide cystogram as early as possible to rule out VUR and other congenital urologic anomalies,3 the current guidelines do not advocate VCUG in all children.4 This is consequent to the body of evidence questioning the significance of chemoprophylaxis after a diagnosis of VUR in all children. In our study population, of the 77 boys who underwent both RBUS and
Conclusions
With the current understanding of VUR and the less convincing role of intervention in low-grade VUR, RBUS alone is sufficient in most boys with a first episode of febrile UTI. Investigation related-morbidity is avoided without an added risk of missing clinically significant diagnosis. Performing VCUG in those with suspicious findings on RBUS or recurrent UTI will increase the yield of lesions that warrant intervention and minimize the anxiety related to diagnosing low-grade VUR.
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Cited by (10)
Probabilities of Dilating Vesicoureteral Reflux in Children with First Time Simple Febrile Urinary Tract Infection, and Normal Renal and Bladder Ultrasound
2016, Journal of UrologyCitation Excerpt :Conversely VUR is more prevalent in girls if the RBUS is normal.7,8 Moreover, the chance of detecting significant findings on VCUG is low in boys 1 to 10 years old with normal RBUS.25 In our study gender was not a risk factor for dilating VUR.
Urinary tract infection in pediatrics: an overview
2020, Jornal de PediatriaCitation Excerpt :None of these recent guidelines recommend routine VCUG or DMSA scans, but they recommend further evaluation if the ultrasound is abnormal, if the child is critically ill and fails to respond promptly to antibiotics, and in case of recurrent infections. Some studies have evaluated the impact of fewer investigations and concluded that the recent guidelines are safe to follow.88–90 On the other hand, other authors consider that potentially important abnormalities will be missed if the newer guidelines are followed.91
Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?
2021, Frontiers in PediatricsUrinary tract infection
2016, Clinical Pediatric Nephrology: Third Edition
Financial Disclosure: The authors declare that they have no relevant financial interests.