Indication for voiding cystourethrography during first urinary tract infection

Abstract

Background There is confusion surrounding the precise indications for voiding cystourethrography (VCUG) during the assessment of vesicoureteral reflex (VUR) after a first febrile urinary tract infection (UTI). The aim of this study was to determine the combination of clinical, laboratory and ultrasonography factors correlating with grades IV–V VUR in young children with a first febrile UTI. Methods Children 0–24 months of age who were brought to the emergency department at National Center for Child Health and Development with the diagnosis of first time febrile UTI between March 2004 and May 2011, were enrolled. We compared clinical, laboratory and ultrasonography findings between children with grades IV–V VUR (high‐grade VUR) and those with no or grades I–III VUR (normal or low‐grade VUR). Results A total of 231 patients were eligible and 19 had high‐grade VUR. Poor clinical appearance, presence of a uropathogen other than Escherichia coli, positive blood culture, hydroureter and thickened renal pelvic wall were all independently associated with high‐grade VUR. When one or more of these factors were present, sensitivity, specificity, positive or negative predictive value, and positive or negative likelihood ratio were 94.7%, 69.4%, 23.1%, 99.3%, 3.1 and 0.1, respectively. When none of the factors was present, the proportion of high‐grade VUR was 0.7%; if one factor, 11.3%; two factors, 55.6%; three factors, 85.7%. Conclusions In the absence of five specific factors during the first febrile UTI episode in young children, VCUG is not necessary to detect high‐grade VUR. When more than one factor is present, however, VCUG is indicated.

Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2‐ to 24‐month‐old children

“…The cohort was different from those in the US and European countries, where females accounted for about 65%–75% 10,23 . However, the cohort in this study was representative of a typical group of Japanese UTI children 17 . The difference between the ethnicities needs to be considered when applying the new criteria.…”

“…In this study, non‐ E. coli infection was the most closely associated factor with clinically significant urological anomalies. Many studies report that non‐ E. coli infection is one of the risk factors for renal malformations and scarring, 17,19,22–24 and one bacterial attachment study supports it 25 . The 2007 NICE guideline and the 2019 Italian guidelines demonstrate that VCUG should be performed for non‐ E. coli infections 5,8 .…”

“…10,23 However, the cohort in this study was representative of a typical group of Japanese UTI children. 17 The difference between the ethnicities needs to be considered when applying the new criteria. Fourth, we did not evaluate the failure to respond to treatment with suitable antibiotics within 48 h 8 or the clinical presentations.…”

A correlation study of the effectiveness of renal scintigraphy and sonography in the detection and evaluation of renal disorders

“…For this purpose, ultrasonography is routinely practiced [18]. Voiding cystourethrography (VCUG) is recommended if ultrasonography diagnoses scarring, hydronephrosis or other ndings suggestive of obstructive uropathy or vesicoureteral re ux [19]. Renal scintigraphy scan is a preferred diagnostic test to estimate GFR and blood ow in kidneys [20].…”

Vesicoureteral Reflux and Renal Scarring in Children with Acute Pyelonephritis: the Role of Late 6-month Dimercaptosuccinic Acid Renal Scan

“…Therefore, it is recommended during acute and follow-up phases of febrile UTIs. VCUG is indicated when DMSA scan reveals acute cortical defects 15) . This finding is highly debated due to the radiation burden 16,17) .…”