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Prediction of vesico-ureteral reflux in children from intravenous urography films
Insights
Intravenous urography is recommended for children with urinary tract infections, as it effectively identifies abnormalities. Clinically significant vesico-ureteral reflux can be predicted from urography alone, potentially avoiding further tests.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs) are common in children.
- Abnormalities in the urinary tract can lead to recurrent UTIs and complications.
Purpose of the Study:
- To evaluate the diagnostic utility of intravenous urography (IVU) and voiding urethrocystography (VUCG) in children with UTIs.
- To determine the predictability of vesico-ureteral reflux (VUR) from IVU findings.
Main Methods:
- Retrospective analysis of 255 children with UTIs who underwent both IVU and VUCG.
- Assessment of urinary tract abnormalities and VUR detection rates.
- Evaluation of radiologist's ability to predict VUR from IVU films.
Main Results:
- 34% of children had urinary tract abnormalities.
- Vesico-ureteral reflux was found in 19% of ureters (27% of children).
- Radiologists had high false-negative rates for predicting VUR from IVU alone, but were accurate for clinically significant reflux (Grades III-V).
Conclusions:
- IVU is a valuable routine investigation for children with their first UTI.
- VUCG may not be necessary for children with normal IVU findings, especially if clinically significant VUR is absent.
- VUCG can be deferred in cases of negative IVU or if VUR is not clinically significant.
Abstract:
Intravenous urography and voiding urethrocystography were performed on 255 children with urinary tract infection. Eighty-six (34%) of these children had some kind of abnormality of the urinary tract. Vesico-ureteral reflux was observed to 96 ureters (19%) in 69 children (27%). The prediction of vesico-ureteral reflux by two radiologists from urography films only gave 46 (48%) and 51 (53%) false negative results respectively. In cases of clinically important reflux (III--V degrees), however, the rate of false negative predictions was 0/18 and 1/18 (6%) respectively. The rate for false positive predictions were 45/413 (11%) for both radiologists. In view of the number of pathological findings in this series i.v. urography is recommended as a routine in children undergoing urological work-up after their first urinary tract infection. As the clinically important vesico-ureteral reflux seems to be predictable from urography films alone, voiding urethrocystography seems not to be justified in children with negative i.v. urography, and can be postponed and carried out later if the urinary tract infection recurs.