MP44-08 IMAGING AFTER UTI IN OLDER CHILDREN AND ADOLESCENTS

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Relux1 Apr 2014MP44-08 IMAGING AFTER UTI IN OLDER CHILDREN AND ADOLESCENTS Michael P. Kurtz, Jeanne S. Chow, Emilie K. Johnson, William Tan, Tanya Logvinenko, and Caleb P. Nelson Michael P. KurtzMichael P. Kurtz More articles by this author , Jeanne S. ChowJeanne S. Chow More articles by this author , Emilie K. JohnsonEmilie K. Johnson More articles by this author , William TanWilliam Tan More articles by this author , Tanya LogvinenkoTanya Logvinenko More articles by this author , and Caleb P. NelsonCaleb P. Nelson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives While the 2011 AAP guidelines for evaluation after urinary tract infection (UTI) focused on infants age 2-24 months, there are few guidelines or data regarding workup in older children. Both voiding cystourethrogram (VCUG) and renal and bladder ultrasound (RBUS) have been used in such patients, but the value of such tests is uncertain. We sought to determine the clinical yield of RBUS and VCUG among older children and adolescents after UTI. Methods We analyzed VCUG and RBUS findings and clinical history of 3995 patients who underwent both studies on the same date between 1/06-12/10, and selected patients age 5-18 years who underwent imaging for indication of UTI. Patients with prior postnatal GU imaging or history of prenatal hydronephrosis (PNH) were excluded. RBUS was defined as positive for any degree of hydronephrosis or hydroureter, renal parenchymal or bladder abnormalities. A positive VCUG was defined as VUR>GII and/or bladder or urethral anomalies (e.g. diverticulum). Results We identified a cohort of 141 patients, 77% were of age 5-8 years, 29% age 8-12, and 2.8% age 12-18. 76.6% were female. 78.7% patients had a history of febrile UTI; 53.9% had a history of recurrent UTI. RBUS findings among girls included 9.2% hydronephrosis, 2.8% with ureteral dilation, 13% with renal parenchymal findings, and 9.2% with bladder findings. Among boys, 6.1% had hydronephrosis, 9.1% had ureteral dilation, 12% had renal parenchymal findings, and 18% had bladder findings. No subjects had moderate or greater hydronephrosis. On VCUG, VUR was observed in 49/141 subjects (34%); 41/108 (38%) girls and 8/33 (24%) boys. Other bladder or urethral anomalies were seen in 12%. 6.4% of all subjects had grade I, 26.2% had grade II-III, and1.4% had grade >III VUR. One boy had concurrent upper tract obstruction (precluding VUR grading); no boys had VUR > grade II. One boy had a urethral anomaly. Among girls, 1.9% had VUR > grade III. The test characteristics (with 95% CI) of any RBUS abnormality for VUR > grade II (or bladder or urethral anomalies) were: sensitivity 0.53 (0.36-0.70), specificity 0.71 (0.62-0.79), PPV 0.33 (0.22-0.48), NPV 0.85 (0.76-0.91). For any VUR grade (or bladder or urethral anomalies), these were: sensitivity 0.49 (0.37-0.62), specificity 0.76 (0.66-0.84), PPV 0.58 (0.44-0.71), NPV 0.69 (0.59-0.77). Conclusions Among older children with a history of UTI, mild genitourinary anomalies are common, but the yield of diagnostic imaging high grade hydronephrosis or high-grade VUR is very low. Renal ultrasound is not reliable as a screening test for predicting VCUG findings such as VUR, regardless of grade. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e445-e446 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael P. Kurtz More articles by this author Jeanne S. Chow More articles by this author Emilie K. Johnson More articles by this author William Tan More articles by this author Tanya Logvinenko More articles by this author Caleb P. Nelson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...