Is Evaluation with Voiding Cystourethrography Necessary for Children with a Febrile Urinary Tract Infection?

Ha, You Shin; Suh, Hong Jin; Lee, Dong Hwan

Abstract

PURPOSE: In the diagnosis of pediatric urinary tract infection(UTI), the use of invasive methods, such as voiding cystourethrography(VCUG), is controversial. A retrospective study was carried out to evaluate the necessity for VCUG in assessing pediatric UTI.
MATERIALS AND METHODS
Between April 2000 and March 2002, 70 children (60 boys, 10 girls) with symptomatic UTI were evaluated. All patients were evaluated with renal ultrasonography(RUS), 99mTc-DMSA renal scintigraphy(DMSA renal scan) and VCUG. The results of the VCUG were compared with RUS and similar comparisons made between the results of the VCUG and DMSA renal scans. Patients with both normal a RUS and DMSA renal scan were then evaluated for the frequency and grade of vesicoureteral reflux(VUR) on the VCUG.
RESULTS
The mean age at the initial evaluation was 7.95 months, ranging from 1 to 52 months. RUS and DMSA scan abnormalities were found in 38(54.3%) and 26(37.1%) children, respectively. Of the 22 patients with VUR confirmed by VCUG, 11(50.0%) had an abnormal RUS, and 12 (54.5%) patients had abnormal DMSA renal scans. Of the 19 patients with both a normal RUS and DMSA scan, 4(21.2%, 6 kidney-ureter unit) were found to have VUR on VCUG.
CONCLUSIONS
This study illustrated that a considerable number of patients may have significant VUR, despite normal renal ultrasonography and DMSA scans. Therefore, VCUG remains important in assessing pediatric UTI.