612 HISTORY OF RECURRENT URINARY TRACT INFECTION AND OTHER FACTORS ARE NOT PREDICTIVE OF ABNORMALITY ON VOIDING CYSTOURETHROGRAM

Abstract

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012612 HISTORY OF RECURRENT URINARY TRACT INFECTION AND OTHER FACTORS ARE NOT PREDICTIVE OF ABNORMALITY ON VOIDING CYSTOURETHROGRAM Ariella Friedman, Cortney Wolfe-Christensen, Amanda Toffoli, Teresa Jones, Thomas Slovis, Jack Elder, and Yegappan Lakshmanan Ariella FriedmanAriella Friedman Detroit, MI More articles by this author , Cortney Wolfe-ChristensenCortney Wolfe-Christensen Detroit, MI More articles by this author , Amanda ToffoliAmanda Toffoli Detroit, MI More articles by this author , Teresa JonesTeresa Jones Detroit, MI More articles by this author , Thomas SlovisThomas Slovis Detroit, MI More articles by this author , Jack ElderJack Elder Detroit, MI More articles by this author , and Yegappan LakshmananYegappan Lakshmanan Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.690AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent American Academy of Pediatrics guidelines against the use of a voiding cystourethrogram (VCUG) after most cases of initial pediatric febrile urinary tract infection (UTI) were made in order to spare patients the discomfort, expense, and radiation exposure associated with the study. It was simultaneously hoped that this would limit the study population to a group with higher theoretical risk for abnormality, increasing the pre-test probability of abnormal findings. Our study aimed to assess factors that may be associated with higher likelihood of abnormal VCUG, which would allow for more judicious recommendation of the test. METHODS A retrospective review was undertaken of all initial VCUGs performed at Children's Hospital of Michigan between January and June, 2010. Patients with prior VCUGs or history of VUR were excluded. Factors that were assessed for increased likelihood of VUR or other Urologic abnormality included degree of bladder distension with contrast medium, department of referring physician, listed indication for VCUG (i.e. UTI, hydronephrosis), mention of recurrent or multiple UTIs on the requisition, and mention of UTI and abnormality on imaging or history that might indicate the need for VCUG (i.e. hydronephrosis, family history of VUR). ANOVA and Chi-Square tests were performed where appropriate with SPSS. RESULTS Two hundred and sixty four patients underwent initial VCUG during this period. VUR was detected in 57 (21.5%), and Urologic abnormality including VUR was detected in 73 (27.7%). Degree of bladder distension (p=0.266), department of referring physician (p=0.755), indication for study (p=0.580), and history of recurrent UTI or UTI and other abnormality (p=0.742) were all not associated with increased likelihood of VUR. Similarly, degree of bladder distension (p=0.709), department of referring physician (p=0.472), indication for study (p=0.648), and history of recurrent UTI or UTI and other abnormality (p=0.949) were all not associated with increased likelihood of any Urologic abnormality on VCUG. CONCLUSIONS The likelihood of an abnormal VCUG is not increased when performed after recurrent UTI, nor when performed in the setting of UTI and other abnormality on history or radiologic exam. This reasons against postponing a VCUG until after a second UTI, as the probability of a positive finding is no greater in this setting. Degree of bladder distension during the study and department of referring physician further do not contribute to the likelihood of a positive study. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e249 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ariella Friedman Detroit, MI More articles by this author Cortney Wolfe-Christensen Detroit, MI More articles by this author Amanda Toffoli Detroit, MI More articles by this author Teresa Jones Detroit, MI More articles by this author Thomas Slovis Detroit, MI More articles by this author Jack Elder Detroit, MI More articles by this author Yegappan Lakshmanan Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...