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Ultrasonography as a screening procedure in children with urinary tract infection
Insights
Renal ultrasonography is the preferred initial imaging for children with urinary tract infections (UTIs). This approach helps identify abnormalities and guides further diagnostic steps, reducing unnecessary procedures.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTIs) are common in children and can lead to significant renal damage if not properly managed.
- Identifying anatomical or functional abnormalities is crucial for effective treatment and prevention of recurrent UTIs.
Purpose of the Study:
- To evaluate the efficacy of different imaging modalities in the initial assessment of children diagnosed with urinary tract infections.
- To determine the optimal imaging protocol to minimize radiation exposure, patient discomfort, and healthcare costs.
Main Methods:
- A retrospective analysis of 76 children with UTIs who underwent renal ultrasonography, excretory urography, and voiding cystourethrography (VCUG) or radionuclide-voiding cystography (R-VCG).
- Correlation of imaging findings with the presence of functional or anatomical abnormalities, including vesicoureteral reflux and obstructive lesions.
Main Results:
- Forty children (52.6%) had functional or anatomical abnormalities, including 28 with vesicoureteral reflux and 12 with obstructive lesions.
- Renal ultrasonography detected 14 of the 16 cases requiring surgery, with VCUG identifying the remaining two.
- Ultrasonography identified abnormalities in 14 of the 16 cases requiring surgery.
Conclusions:
- Renal ultrasonography is recommended as the initial imaging modality for children with UTIs.
- Voiding cystourethrography (conventional or radionuclide) should follow ultrasonography for further evaluation.
- Excretory urography is reserved for cases with suspected upper urinary tract abnormalities identified by initial imaging.
Abstract:
Renal ultrasonography, excretory urography and radionuclide-voiding cystography or conventional voiding cystourethrography were performed in 76 children with urinary tract infection. Forty children had functional or anatomical abnormalities. Twenty-eight children had vesicoureteral reflux and 12 children had an obstructive lesion. All 12 children with obstructive lesions as well as 4 children with reflux and hydronephrosis required corrective surgery. Ultrasonography as the initial procedure detected 14 of these cases and the other 2 were discovered in voiding cystourethrography. Our data and those in the literature suggest that renal ultrasonography may be the method of choice in children with urinary tract infection. This is followed by voiding cystourethrography or radionuclide-voiding cystography. Excretory urography is not necessary in the initial evaluation of these patients, but it should be utilized when the other imaging methods show an abnormality and more detailed anatomical visualization of the upper urinary tract is required. Using this protocol in children with urinary tract infection, unnecessary radiation, discomfort and expense will be avoided.