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The PIC cystogram: its place in the treatment algorithm of recurrent febrile UTIs

Jennifer A Hagerty1, Max Maizels, Earl Y Cheng

  • 1Department of Pediatric Urology, Children's Memorial Hospital, 2300 Children's Plaza, Box 24, Chicago, IL 60614, USA. jhagerty@childrensmemorial.org

Advances in Urology
|August 7, 2008
PubMed

Insights

A new cystogram technique, positioning contrast at the ureteral orifice (PIC), helps identify occult vesicoureteral reflux (VUR) in children with recurrent febrile urinary tract infections (UTIs) despite normal initial tests.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Urology

Background:

  • Recurrent febrile urinary tract infections (UTIs) in children often present a diagnostic challenge, particularly when initial imaging like voiding cystourethrograms (VCUGs) are normal.
  • Occult vesicoureteral reflux (VUR) can be a contributing factor in these cases, leading to persistent infections.

Purpose of the Study:

  • To review the evidence supporting the use of a specialized cystogram technique, positioning contrast at the ureteral orifice (PIC), for diagnosing VUR.
  • To evaluate the clinical utility of PIC cystography in managing pediatric patients with recurrent febrile UTIs and negative VCUGs.

Main Methods:

  • A comprehensive literature search was conducted to identify and analyze all studies investigating PIC cystography.
  • Evaluation focused on studies reporting the diagnostic accuracy and clinical outcomes associated with PIC cystography.

Main Results:

  • PIC cystography has shown efficacy in identifying "occult reflux" (PIC-VUR) in children with febrile UTIs and normal VCUGs.
  • Treatment of identified PIC-VUR has led to a significant decrease in the recurrence of febrile UTIs in these pediatric patients.

Conclusions:

  • PIC cystography appears to be a valuable diagnostic tool for a specific subset of children experiencing recurrent febrile UTIs where conventional VCUGs do not reveal VUR.
  • While current literature is limited, ongoing research, including a prospective randomized trial, aims to further clarify the role of PIC cystography in the management algorithm for febrile UTIs.
Abstract

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