Timing of voiding cystourethrography after febrile urinary tract infection in children: a systematic review

Abstract

BackgroundDespite a trend towards early voiding cystourethrography (VCUG) after febrile urinary tract infection (fUTI) in children, clinical guidelines do not comment on the optimal timing and current practice varies considerably.ObjectiveTo assess whether the detection rate of vesicoureteric reflux (VUR) in children depends on the time period of VCUG procedure after onset of antibiotic therapy.MethodsMEDLINE, EMBASE and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language or time restriction (19 November 2018). Inclusion criteria were (1) patients <18 years of age; (2) VCUG performed in patients with fUTI after onset of antibiotic therapy either in the same patient population or in two or more different patient populations within one study at different time periods; and (3) with reported detection rate of VUR. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsOf 4175 records, nine studies were included (number of patients, n=1745) for the main outcome prevalence of VUR by VCUG <8 days compared with VCUG ≥8 days after onset of antibiotic therapy. Pooled overall prevalence of VUR was not significantly different between the early and the late VCUG groups (risk ratio 0.98, 95% CI 0.81 to 1.19). Prevalence of VUR stratified by grade was not significantly different between the two groups.ConclusionEarly VCUG within 8 days after onset of antibiotic therapy does not affect the prevalence of VUR.Trial registration numberCRD42018117545

Update of the EAU/ESPU guidelines on urinary tract infections in children

“…VCUG can also exclude the presence of an infravesical obstruction. The timing of VCUG does not influence the presence or severity of VUR [23]. When performed with proven sterile urine, it does not cause any significant morbidity [24].…”

Swiss consensus recommendations on urinary tract infections in children

“…If MCUG is indicated after UTI, it may be performed as soon as available by the local radiology department. The early timing of MCUG (within 8 days after onset of antimicrobial therapy) does not influence the detection of VUR as shown in a recent review [47].…”

Diagnosis and management of community-acquired urinary tract infection in infants and children

“… Renal scintigraphy using dimercaptosuccinic acid (DMSA) is the most sensitive test used to diagnose pyelonephritis during the acute phase of infection, and furthermore, detect the area of renal scar when performed months after the acute infection [ 48 ]. DMSA scan is an invasive test that involves an intravenous injection, several hours in hospital, and radiation exposure to the child [ 48 ]. SPIDS does not recommend using DMSA in the routine evaluation of children after first UTI.…”