Related Experiment Videos
[Urethrocystography in children. Practical considerations of irradiation doses]
E Martín Hernández1, A Fernández Posada, B García Ibañez
1Servicio de Pediatría, Hospital Príncipe de Asturias, Universidad de Alcalá de Henares.
Insights
Rational use of voiding cystourethrography (VCUG) is crucial due to radiation exposure. This study suggests limiting VCUG in older children with normal ultrasounds and considering nuclear cystography for girls to reduce unnecessary procedures.
Area of Science:
- Pediatric Radiology
- Urology
Background:
- Voiding cystourethrography (VCUG) is an invasive diagnostic tool for pediatric urinary tract issues.
- VCUG involves ionizing radiation, necessitating careful consideration of its use.
- Reducing radiation exposure in pediatric imaging is a significant concern.
Purpose of the Study:
- To evaluate the diagnostic yield of VCUG in children.
- To identify indications for VCUG that may be questionable.
- To contribute to reducing radiation dose in pediatric VCUG procedures.
Main Methods:
- Retrospective review of 125 pediatric VCUG records.
- Analysis of indications, findings, and patient demographics.
- Correlation of VCUG results with ultrasound and Tc99 DMSA findings.
Main Results:
- Vesicoureteric reflux (VUR) was associated with febrile UTI and fetal hydronephrosis, particularly in infants.
- 100 out of 125 VCUGs were normal; 13 showed VUR.
- Preliminary X-rays were abnormal in only 3 cases, suggesting limited utility.
Conclusions:
- VCUG is strongly linked to febrile UTI and fetal hydronephrosis; other indications warrant scrutiny.
- VCUG may not be necessary for children aged 6+ with normal ultrasound and Tc99 DMSA after a first UTI.
- Nuclear cystography could be an alternative to VCUG in specific pediatric populations, and preliminary X-rays are not justified.
Objective:
Rational use of voiding cystourethrography (VCUG) is imperative, as it is an invasive procedure exposing the child to ionizing radiation and other well documented risks. The objective of this study was to contribute to the achievement of a reduction in the irradiation dose in VCUG.
Patients And Methods:
We reviewed the medical records of a consecutive sample of 125 children that underwent VCUG in our hospital between January 1995 and June 1996.
Results:
Of the 125 VCUGs, 100 were normal, 13 showed vesicoureteric reflux grade II or higher, and 12 of them presented with other anomalies. The indication for VCUG was febrile UTI in 54 children, hydronephrosis detected prenatally in 12 and other causes in 60 children. It is important to note that children with vesicoureteric reflux presented as febrile UTI or fetal hydronephrosis. The age was significantly lower in the reflux group (p < 0.01). Eleven of the 13 children with vesicoureteric reflux were less than one year of age. Ultrasound anomalies and renal scarring in Tc99 DMSA were seen in a larger proportion in the reflux group. Preliminary X-rays showed anomalies in only 3 of 125 cases.
Conclusions:
1) Vesicoureteric reflux is related to febrile UTI and fetal hydronephrosis. The other indications are questionable. 2) VCGU is not recommended following the first UTI in the evaluation of children 6 years of age or older who have a normal ultrasound and Tc99 DMSA. 3) VCUG could be substituted by a nuclear cystogram in girls who do not have a history of voiding dysfunction. 4) A preliminary X-ray is not justified.