The role of voiding cystourethrography in the investigation of children with urinary tract infections

Authors

  • Linda C. Lee The Hospital for Sick Children
  • Armando J. Lorenzo The Hospital for Sick Children
  • Martin A. Koyle The Hospital for Sick Children

DOI:

https://doi.org/10.5489/cuaj.3610

Abstract

Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25‒40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs.

Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG.

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Author Biographies

Linda C. Lee, The Hospital for Sick Children

Paediatric Urology Fellow

Division of Urology, Department of Surgery

Armando J. Lorenzo, The Hospital for Sick Children

Associate Professor

Division of Urology, Department of Surgery

 

Martin A. Koyle, The Hospital for Sick Children

Professor

Division of Urology, Department of Surgery

 

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Published

2016-06-16

How to Cite

Lee, L. C., Lorenzo, A. J., & Koyle, M. A. (2016). The role of voiding cystourethrography in the investigation of children with urinary tract infections. Canadian Urological Association Journal, 10(5-6), 210–4. https://doi.org/10.5489/cuaj.3610

Issue

Vol. 10 No. 5-6 (2016): CUAJ June

Section

Review

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