Imaging of children with urinary tract infection: a tailored approach

We reviewed the initial imaging studies of 283 children with urinary tract infection in order to decide on the most effective approach. A voiding cystogram was performed in all, complemented by either urography (147 patients), ultrasonography (65), or both (71 patients). In the latter group there was good correlation between sonographic and urographic findings, except for a more accurate delineation of renal scars and anomalies on urography, all in children with vesicoureteral reflux and/or abnormal sonograms. From these data we derived two imaging sequences tailored to the clinical circumstances: cystography as the initial study in ambulatory patients after infection has subsided, and sonography followed by cystography in children hospitalised with severe infection. The upper tracts are studied by ultrasonography and/or urography in patients with significant vesicoureteral reflex or an abnormal sonogram. Both these sequences reduce radiation by omitting the urogram in roughly half of the patients.