Diagnosis and imaging in urinary tract infections

The aim of imaging in urinary tract infection is to detect conditions that must be treated in order to avoid immediate deterioration or recurrences, and probable long-term kidney damage. In newborns identified with hydronephrosis during pregnancy or by neonatal screening, vesicoureteral reflux and renal scarring are congenital and not caused by infection. Most of these patients are male and the vesicoureteral reflux is of a higher grade than that detected in girls having had urinary tract infection. In children with urinary tract infection, several authors advocate a more selective policy and recommend imaging only in those children who are at risk for developing renal damage. In adult females no imaging is necessary in cystitis, whereas ultrasonography and plain films are recommended in acute pyelonephritis. Because uncomplicated urinary tract infection in men is rare, diagnostic evaluation including imaging should be started early in order to rule out complicating factors within the urinary tract. The role of imaging in prostatitis, vesiculitis, epididymitis and orchitis is primarily to rule out abscess formation, but also to exclude testicular malignancies.