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Value of cystography in urinary tract infections
Insights
For children with a urinary tract infection (UTI), an intravenous urogram (IVU) may be sufficient. Micturating cystography can often be deferred if the IVU is normal, avoiding unnecessary procedures.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging in Urology
Background:
- Urinary tract infections (UTIs) are common in children.
- Renal scarring and damage result from recurrent UTIs, not solely from vesicoureteral reflux.
- The role of routine micturating cystography after a first UTI is debated.
Purpose of the Study:
- To evaluate the necessity of micturating cystography in children with bacteriologically proven UTIs.
- To determine if deferring cystography in cases of normal intravenous urograms is a safe and effective strategy.
Main Methods:
- A cohort of 51 children with confirmed UTIs underwent both intravenous urogram (IVU) and micturating cystography.
- Intravenous urogram (IVU) findings were analyzed.
- Micturating cystogram results, specifically vesicoureteral reflux, were correlated with IVU findings.
Main Results:
- Out of 51 children, 35 had a normal IVU.
- In children with a normal IVU, only 6 demonstrated vesicoureteral reflux on cystography.
- Vesicoureteral reflux was identified in 7 out of 70 at-risk ureters.
Conclusions:
- Vesicoureteral reflux alone does not cause renal damage; super-added infection is the critical factor.
- Routine micturating cystography may be unnecessary for children with a normal IVU and a single UTI, provided urine remains sterile.
- Deferring cystography until recurrent infections occur in a hospital setting can avoid this investigation for many children.
Abstract:
Fifty-one children with a bacteriologically proven urinary tract infection had both an intravenous urogram (IVU) and a micturating cystogram. The IVU was normal in 35. Only 6 of these children showed reflux in the cystogram, affecting 7 of the 70 ureters at risk. Since reflux on its own does not cause renal damage, which occurs only with super-added infection, detection of reflux is not important providing the urine is kept sterile. We suggest that cystography be deferred providing the IVU is normal until recurrent infections occur while under hospital care, and, with this policy this unpleasant and sometimes hazardous investigation could be avoided in many children with a single urinary tract infection.