Abstract
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.
Similar content being viewed by others
References
Koyle MA, Elder JS, Skoog SJ et al (2011) Febrile urinary tract infection, vesicoureteral reflux, and renal scarring: current controversies in approach to evaluation. Pediatr Surg Int 27:337–346
Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement Management (2011) Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2–24 months. Pediatrics 128:595–610
Rachmiel M, Aladjem M, Starinsky R et al (2005) Symptomatic urinary tract infections following voiding cystourethrography. Pediatr Nephrol 20:1449–1452
Stashinko EE, Goldberger J (1998) Test or trauma? The voiding cystourethrogram experience of young children. Issues Compr Pediatr Nurs 21:85–96
Phillips DA, Watson AR, MacKinlay D (1998) Distress and the micturating cystourethrogram: does preparation help? Acta Pediatr 87:175–179
Hoberman A, Charron M, Hickey RW et al (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:195–202
Manhant S, Friedman J, MacArthur C (2002) Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection. Arch Dis Child 86:419–420
Abdulnour HA, Williams JL, Kairalla JA et al (2012) Does hydronephrosis predict the presence of severe vesicoureteral reflux? Eur J Pediatr 171:1605–1610
Saadeh SA, Mattoo TK (2011) Managing urinary tract infection. Pediatr Nephrol 26:1967–1976
Lee JH, Kim MK, Park SE (2012) Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection? Acta Paediatr 101:e105–e109
Pannesi M, L’Erario I, Travan L et al (2012) Managing children under 36 months of age with febrile urinary tract infection: a new approach. Pediatr Nephrol 27:611–615
Coulthard MG, Verber I, Jani JC et al (2009) Can prompt treatment of childhood UTI prevent kidney scarring? Pediatr Nephrol 24:2059–2063
Oh MM, Cheon J, Kang SH et al (2010) Predictive factors for acute renal cortical scintigraphic lesion and ultimate scar formation in children with first febrile urinary tract infection. J Urol 183:1146–1150
Jodal U, Winberg J (1987) Management of children with unobstructed urinary tract infection. Pediatr Nephrol 1:647–656
Winter AL, Hardy BE, Alton DJ et al (1983) Acquired renal scars in children. J Urol 129:1190–1194
Iannelli V (2011) New AAP Urinary Tract Infection Guidelines. http://pediatrics.about.com/b/2011/08/29/new-aap-urinary-tract-infection-guidelines.htm. Accessed 14 Jan 2013
Hannula A, Venhola M, Renko M et al (2010) Vesicoureteral reflux in children with suspected and proven urinary tract infection. Pediatr Nephrol 25:1463–1469
Shaikh N, Ewing AL, Bhatnager S et al (2010) Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics 126:1084–1091
Jacobson SH, Eklöf O, Eriksson CG et al (1989) Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ 299:703–706
Wennerström M, Hansson S, Hedner T et al (2000) Ambulatory blood pressure 16–26 years after the first urinary tract infection in childhood. J Hypertens 18:485–491
Martinell J, Lidin-Janson G, Jagenburg R et al (1996) Girls prone to urinary infections followed into adulthood. Indices of renal disease. Pediatr Nephrol 10:139–142
Leroy S, Gervaix A (2011) Procalcitonin: a key marker in children with urinary tract infection. Adv Urol. doi:10.1155/2011/397618
Lee MD, Lin CC, Huang FY et al (2009) Screening young children with a first febrile urinary tract infection for high-grade vesicoureteral reflux with renal ultrasound scanning and technetium-99 m-labeled dimercaptosuccinic acid scanning. J Pediatr 154:797–802
Herz D, Merguerian P, McQuinston L et al (2010) 5-year prospective results of dimercapto-succinic acid imaging in children with febrile urinary tract infection: proof that the top-down approach works. J Urol 184:1703–1709
Moorthy I, Easty M, McHugh K et al (2005) The presence of vesicoureteric reflux does not identify a population at risk for renal scarring following a first urinary tract infection. Arch Dis Child 90:733–736
Ward VL, Strauss KJ, Barenwolt CE et al (2008) Pediatric radiation exposure and effective dose reduction during voiding cystourethrography. Radiology 249:1002–1009
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Friedman, A.A., Wolfe-Christensen, C., Toffoli, A. et al. History of recurrent urinary tract infection is not predictive of abnormality on voiding cystourethrogram. Pediatr Surg Int 29, 639–643 (2013). https://doi.org/10.1007/s00383-013-3301-0
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-013-3301-0