Voiding Cystourethrograms and Urinary Tract Infections:  How Long to Wait?

McDonald, Anu; Scranton, Maria; Gillespie, Robert J.; Mahajan, Vandana; Edwards, George A.

doi:10.1542/peds.105.4.e50

Cited by 58 publications

(30 citation statements)

References 14 publications

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“…Data on the prevalence of VUR among children without a history of UTI do not (1997) Cross-sectional study of children Ͻ5 y of age with first UTI 272 28 McDonald et al 52 (2000) Retrospective chart review of children with VCUG after UTI 176 19 Oostenbrink et al 53 (2000) Cross-sectional study of children Ͻ5 y of age with first UTI 140 26 Mahant et al 54 (2001) Retrospective chart review of children with VCUG after UTI 162 22 Mahant et al 55 (2002) Retrospective review of VCUG in children Ͻ5 y of age admitted with first UTI 162 22 Chand et al 56 (2003) Retrospective review of VCUG or radionuclide cystogram in children Ͻ7 y of age 15 504 35 Fernandez-Menendez et al 44 (2003) Prospective cohort study of 158 children Ͻ5 y of age (85% Ͻ 2 y) with first UTI 158 22 Camacho et al 41 (2004) Prospective cohort study of children 1 mo to 12 y of age (mean age: 20 mo) with first febrile UTI Figure 3 shows the prevalence of VUR plotted as a function of the midpoint of each age stratum.…”

Section: Prevalence Of Vurmentioning

confidence: 99%

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Finnell¹,

Carroll²,

Downs³

2011

Pediatrics

178

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OBJECTIVES: The diagnosis and management of urinary tract infections (UTIs) in young children are clinically challenging. This report was developed to inform the revised, evidence-based, clinical guideline regarding the diagnosis and management of initial UTIs in febrile infants and young children, 2 to 24 months of age, from the American Academy of Pediatrics Subcommittee on Urinary Tract Infection. METHODS: The conceptual model presented in the 1999 technical report was updated after a comprehensive review of published literature. Studies with potentially new information or with evidence that reinforced the 1999 technical report were retained. Meta-analyses on the effectiveness of antimicrobial prophylaxis to prevent recurrent UTI were performed. RESULTS: Review of recent literature revealed new evidence in the following areas. Certain clinical findings and new urinalysis methods can help clinicians identify febrile children at very low risk of UTI. Oral antimicrobial therapy is as effective as parenteral therapy in treating UTI. Data from published, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI when vesicoureteral reflux is found through voiding cystourethrography. Ultrasonography of the urinary tract after the first UTI has poor sensitivity. Early antimicrobial treatment may decrease the risk of renal damage from UTI. CONCLUSIONS: Recent literature agrees with most of the evidence presented in the 1999 technical report, but meta-analyses of data from recent, randomized controlled trials do not support antimicrobial prophylaxis to prevent febrile UTI. This finding argues against voiding cystourethrography after the first UTI.

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Section: Prevalence Of Vurmentioning

confidence: 99%

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Finnell¹,

Carroll²,

Downs³

2011

Pediatrics

178

View full text Add to dashboard Cite

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“…While debate exists regarding the timing of a VCUG study, it is generally accepted that it can be performed once the child is afebrile and has a negative urine culture (47). Compliance also appears to be better when the VCUG is performed early after a UTI (51). While no test is perfect, there is little question about the VCUG's ability to detect reflux.…”

Section: Standard Radiological Studiesmentioning

confidence: 99%

Diagnosis and Management of Pediatric Urinary Tract Infections

2005

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Urinary tract infection (UTI) is among the most commonly diagnosed bacterial infections of childhood. Although frequently encountered and well researched, diagnosis and management of UTI continue to be a controversial issue with many challenges for the clinician. Prevalence studies have shown that UTI may often be missed on history and physical examination, and the decision to screen for UTI must balance the risk for missed infections with the cost and inconvenience of testing. Interpretation of rapid diagnostic tests and culture is complicated by issues of contamination, false test results, and asymptomatic colonization of the urinary tract with nonpathogenic bacteria. The appropriate treatment of UTI has been controversial and has become more complex with the emergence of resistance to commonly used antibiotics. Finally, the anatomic evaluation and long-term management of a child after a UTI have been based on limited evidence, and newer studies question some of the tenets of prior recommendations. The goal of this review is to provide an up-to-date summary of the literature with particular attention to practical questions about diagnosis and management for the clinician

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“…[14,15] Vesicoureteral reflux was detected in 19-21.6% of the patients younger than 10 years after the first UTI. [9,16] In our study, VUR was detected in 61 (38.3%) of 159 patients who underwent VCUG. More than half of (53.8%) the patients with recurrent UTI and pathological renal US findings had VUR.…”

Section: Discussionmentioning

confidence: 48%

“…However, there is no consensus on timing and indication of VCUG. [9,10] Gonadal radiation exposure is the main reason for restricting the use of VCUG. [11] Clinically, VUR is generally identified for the evaluation of antenatal hydronephrosis or recurrent UTI.…”

Section: Discussionmentioning

confidence: 99%

Voiding cystourethrogram: How much should we be selective?

Yel

Tülpar

Düşünsel

et al. 2017

Turkish Journal of Urology

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Objective: In this study, we examined the patients' characteristics, who underwent voiding cystourethrography (VCUG), in order to determine any selectivity for indication of this invasive method. Material and methods:After exclusion of indications of neurogenic bladder or antenatal hydronephrosis and control VCUGs, 159 VCUGs performed in our clinic within one year were evaluated. Patients are divided into three groups accoding to age. Clinical characteristic and findings of renal ultrasonography (US) and renal scintigraphy were examined.Results: Vesicoureteral reflux (VUR) was detected in 61 (38.3%) of 159 patients who underwent cystourethrographic examinations, in 45.8% of the patients with a history of recurrent urinary tract infection (UTI), in 22.0% of the patients with pathological urinary system US without history of recurrent UTI. High-grade reflux rate was significantly more frequent in renal units with pathological US findings. Severe scar was significantly more frequent in renal units with high-grade reflux when compared to renal units without reflux and those with low-grade reflux. Predictive values of recurrent UTI, scarring status and pathological US for VUR were separately analyzed and seen that likelihood of indicating VUR was increased when all 3 risk factors were assessed together. Conclusion:Vesicoureteral reflux is a problem in which diagnostic process and management strategy should have to be considered in individualized manner for each patient. Before prescribing invasive VCUG, imaging urinary system by US and scintigraphy and determining whether there is recurrent UTI will improve selectivity and success of VCUG.

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Voiding Cystourethrograms and Urinary Tract Infections: How Long to Wait?

Cited by 58 publications

References 14 publications

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children

Diagnosis and Management of Pediatric Urinary Tract Infections

Voiding cystourethrogram: How much should we be selective?

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