Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

Abstract

Voiding cystourethrography is the most important fluoroscopic examination in pediatric urology for the investigation of lower urogenital tract diseases, such as vesicoureteral reflux or urethral stricture. However, this invasive procedure imposes a significant burden on children and their parents, and recently there has been a paradigm shift in the diagnosis and treatment of vesicoureteral reflux. In the 2011 revision, the American Academy of Pediatrics guidelines on urinary tract infection recommended abandoning routine voiding cystourethrography after the first febrile urinary tract infection. In 2014, the randomized intervention for children with vesicoureteral reflux study recommended discontinuation of routine continuous antibiotic prophylaxis for vesicoureteral reflux. The time is now ripe to radically reconsider indications for voiding cystourethrography and the procedure itself.

Retrospective evaluation of the pediatric multicystic dysplastic kidney patients: experience of two centers from southeastern Turkey

“…In the light of these results, we also thought that routine VCUG was unnecessary like these authors pointed out [29,31]. Since VCUG is an invasive process, it is stressful for both patients and their families, along with exposing radiation, urethral trauma, and iatrogenic UTI [32]. Moreover, a spontaneous resolution is possible, especially in low-grade VUR [33].…”

Clinical practice in vesicoureteral reflux with respect to EAU guidelines: A multicenter study

“…Conventional follow‐up after VUR correction operations includes USG and VCUG. USG is noninvasive and radiation free, while VCUG was described as a terrible experience for children because of urethral catheterization and voluntary voiding in public 20 . As the other major drawback, it exposes the child approximately 0.93mGy of radiation 21 .…”

“…USG is noninvasive and radiation free, while VCUG was described as a terrible experience for children because of urethral catheterization and voluntary voiding in public. 20 As the other major drawback, it exposes the child approximately 0.93mGy of radiation. 21 Hence, performing VCUG routinely in long-term follow-up after either ureteroneocystostomy or endoscopic treatment is not recommended any more.…”

Refluxdiagnostik − Pro DMSA

“…Bei diesen Kindern wäre eine primäre MCUG schon alleine aufgrund der Untersuchungsbedingungen von stark eingeschränkter Sensitivität, da davon auszugehen ist, dass sich das Kind unwohl fühlt und wenn überhaupt, die Blase nur unter nicht "alltäglichen" Bedingungen entleert, die bei kleineren Kindern üblichen multiplen Zyklen sind ebenso wenig möglich. Zudem werden MCUG-Untersuchungen gerade von Kindern > 1 Jahr als unangenehm empfunden und erfordern in manchen Fällen sogar die Anwendung von Sedativa [33]. Während die eigentliche "Sensitivität" der Methode natürlich (in Ermangelung eines "Goldstandards") nicht untersucht werden kann, findet sich einiges an interessanter Literatur zu diesem Thema.…”