INTRODUCTION: Vesicoureteral reflux (VUR) is a common pediatric urologic disorder.
After the first urinary tract infection (UTI), imaging studies are recommended, starting with a renal ultrasound (RUS). Voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scan are the other main radiologic studies used to detect VUR. We evaluated the use of RUS as a screening method for VUR in children below 2 years of age, in order to avoid unnecessary VCUG.
MATERIALS AND METHODS: Medical records and imaging studies of infants (< 2 years) who had their first UTI in a 6 year period were retrospectively reviewed. We evaluated the sensitivity, specificity, and negative predictive values of RUS and DMSA for diagnosing VUR.
RESULTS: Among 155 children (51% males) with their first UTI, 148 RUS were performed, 128 VCUG and 29 DMSA. VUR was detected in 21% patients; 14.5% low grade and 6.5% high grade. One hundred and twenty-one patients underwent both RUS and VCUG, 101 RUS were normal and 20 abnormal. Of the normal RUS 98% had no or low grade VUR. Among those with an abnormality on RUS 30% had high grade VUR (P < 0.001).
CONCLUSIONS: After the first UTI in infants (< 2 years) RUS is a good screening method for VUR. Among such shildren with a normal RUS, we do not recommend VCUG or DMSA. In our opinion, VCUG should be performed only in patients with abnormal findings in RUS or in recurrent UTI.
Fuente MÁ, Costa TS, García BS, Serrano MA, Alonso MS, Luján EA. Are you the author?
Department of Pediatrics, Hospital Clínico San Carlos, Madrid, Spain.
Reference: Indian J Urol. 2014 Oct;30(4):383-6.