History of recurrent urinary tract infection is not predictive of abnormality on voiding cystourethrogram

Area of Science:

• Pediatric Nephrology
• Urology
• Diagnostic Imaging

Background:

• The American Academy of Pediatrics advises against routine voiding cystourethrograms (VCUGs) for initial febrile urinary tract infections (UTIs) in children aged 2-24 months.
• This recommendation raises concerns about potentially delayed diagnosis of vesicoureteral reflux (VUR) and increased risk of renal damage.

Purpose of the Study:

• To assess factors associated with a higher likelihood of abnormal VCUG findings.
• To investigate whether UTI recurrence influences the detection rate of VUR or other urologic abnormalities.

Main Methods:

• Retrospective review of 262 initial VCUGs performed between January and June 2010.
• Ascertainment of recurrent UTI history through prior positive cultures or requisition notes.
• Assessment of VUR and overall urologic abnormality rates.

Main Results:

• Vesicoureteral reflux (VUR) was detected in 21.3% of patients; any urologic abnormality was found in 27.4%.
• Factors including bladder distension, referring physician, study indication, positive urine culture, and history of recurrent UTI were not associated with increased likelihood of VUR or urologic abnormality.

Conclusions:

• Abnormalities, including VUR, are not more likely to be detected on VCUG when performed after recurrent UTIs.
• These findings suggest that postponing VCUG until after UTI recurrence is not justified based on increased likelihood of positive findings.