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The lack of correlation between upper tract changes on excretory urography and significant vesicoureteral reflux
Insights
A normal excretory urogram does not rule out vesicoureteral reflux in children with urinary infections. Voiding cystourethrograms are essential for accurate diagnosis in pediatric urinary tract infections.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs) are common in children.
- Vesicoureteral reflux (VUR) is a significant risk factor for recurrent UTIs and renal scarring.
- Excretory urography (EU) and voiding cystourethrography (VCUG) are common diagnostic tools.
Purpose of the Study:
- To evaluate the diagnostic accuracy of excretory urography in detecting vesicoureteral reflux in children with a history of urinary infection.
Main Methods:
- Retrospective review of 391 children's urograms and VCUGs over one year.
- Analysis of the correlation between EU findings and confirmed VUR on VCUG.
Main Results:
- 56% of children with VUR had a normal excretory urogram.
- 63% of children with VUR showed normal findings on EU.
- Grade II or higher VUR was present in 49% of cases with normal EU findings.
Conclusions:
- Excretory urography alone is insufficient for diagnosing VUR in children with UTIs.
- VCUG is a critical component for the comprehensive evaluation of pediatric UTIs to detect VUR.
Abstract:
In a retrospective review of all excretory urograms and voiding cystourethrograms performed in a 1-year period in 391 children evaluated with a history of urinary infection 56 (14 per cent) had vesicoureteral reflux as well as a normal excretory urogram. Of the 89 children in the study with vesicoureteral reflux 56 (63 per cent) had a normal excretory urogram. The grade of reflux was II or greater in 49 per cent of the cases, which also had a normal excretory urogram. We conclude that an excretory urogram without a voiding cystourethrogram is an inadequate study for a child with a history of urinary infection.