Voiding cystourethrography in children: spectrum of findings with clinical correlation

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Samy Salem Mostafa Abdalla ◽  
Samar Ramzy Ragheb ◽  
Shaimaa Abdelsattar Mohammad
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Vesicoureteric Reflux ◽  
Voiding Cystourethrography ◽  
Low Grade ◽  
Older Children ◽  
University Hospitals ◽  
Bladder Abnormalities ◽  
Lower Urinary

Abstract Background Voiding cystourethrography (VCUG) is a gold standard diagnostic tool in the detection of lower urinary tract structural abnormalities in children. Objective To study the spectrum of different urinary tract abnormalities that could be detected in pediatric patients who underwent VCUG. Methods A retrospective study was carried at pediatric radiology unit Ain Shams university hospitals, starting from March 2019 till September 2019. Spectrum of findings were quantified in relation to patients’ symptoms. The number of true acquisitions and fluoroscopic frames, as well as the time of examination, were used as an indicator for radiation dose exposure. Results Out of 134 patients who were included in our study and underwent VCUG, the majority was males (n = 85, 63.4%) and patients who had more than 24 months and less than 216 months with median (IQR) 72 (48-108)months being (n = 82, 61.2%). We found that half of the cases had abnormal VCUG findings (n = 67, 50%). The most common abnormality was vesicoureteric reflux (VUR) (n = 38, 28.4%) followed by bladder abnormalities (n = 14, 10.5%).The commonest presented complaint was urinary tract infection symptoms (n = 58, 43.3%). Infants below 24 months of age showed more abnormal findings than older children. Males showed more abnormal findings than females. High-grade VUR (IV-V) was more frequent than low grade. Both recurrent urinary tract infection (UTI) and bladder abnormalities were found to be strong predictors for VUR (p = 0.019 and 0.013, respectively). The median (IQR) of static films within patients who had abnormal VCUG findings was greater than the median (IQR) of static films within patients who had normal VCUG findings being 7.0 (7.0 – 8.0) versus 6.0 (5.0 – 7.0), respectively with a significant statistically difference (F = 6.571, p = 0.011). Conclusion VCUG can detect different lower urinary abnormalities in children. VUR is the commonest encountered finding during VCUG, especially among patients with recurrent UTI.

Urinary tract infection in children

2017 ◽  
Author(s):  
David F.M Thomas
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Renal Damage ◽  
Vesicoureteric Reflux ◽  
Asymptomatic Bacteriuria ◽  
Clinical Excellence ◽  
Low Grade ◽  
Dysfunctional Voiding

Urinary tract infection (UTI) is one of the commonest conditions of childhood, affecting an estimated 10% of girls and 3% of boys in the first 16 years of life. Whereas asymptomatic bacteriuria and low-grade lower tract infection pose little or no risk of renal damage, pyelonephritis can cause severe systemic illness and poses a significant threat of long-term renal morbidity. The principal aim of investigation is to identify underlying abnormalities of the urinary tract, notably vesicoureteric reflux. Guidelines on investigation and management published by the National Institute of Clinical Excellence will be reviewed in this chapter. Treatment of dysfunctional voiding and other features of ‘elimination syndrome’ plays an important role in the prevention of urinary tract infection in this age group.

Clinical Characteristics of Febrile Urinary Tract Infection and Application of Thai Guideline Imaging Recommendations Compared between Children Aged 2 Months to 2 Years and Children Aged 2 to 5 Years

2021 ◽  
Vol 104 (12) ◽  
pp. 1977-1983
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Imaging Study ◽  
Female Gender ◽  
Voiding Cystourethrography ◽  
Older Children ◽  
Febrile Urinary Tract Infection ◽  
Febrile Uti ◽  
Imaging Recommendations

Background: In 2014, the Thai Pediatric Nephrology Association (TPNA) launched a guideline for febrile urinary tract infection (UTI) in children aged two months to five years. Renal and bladder ultrasound (RBUS) is recommended for first febrile UTI, and voiding cystourethrography (VCUG) is recommended in patients with at least one of eight proposed risk factors. Objective: To compare characteristics of febrile urinary tract infection (UTI), compliance with the imaging study recommendation regarding to the TPNA guide, and kidney, ureter, and bladder (KUB) abnormality detections between children aged two months to two years and older than two years to five years. Materials and Methods: The present study was a retrospective study, reviewed children aged two months to five years presenting with first or recurrent episode of febrile UTI between 2014 and 2019 at Siriraj Hospital. Clinical parameters during febrile UTI, indications to perform VCUG, and kidney, ureter, and bladder (KUB) abnormality detections were compared between the younger group and the older group. RBUS and VCUG undergone according to the recommendation were accounted for the compliance. Results: The mean age of 259 younger and of 51 older age children was 8.2±5.6 and 40.0±10.9 months, respectively. Female gender (p=0.01), complaint of constipation (p=0.03), abnormal bladder emptying (p<0.01), and renal impairment (p=0.03) were more frequent in the older than the younger. Overall imaging study compliance was 73.9% and the KUB abnormality detection was 16.5%. High-grade vesicoureteral reflux (VUR) was more common than low-grade VUR. The rates of compliance (p=0.45) and KUB abnormality detections (p=0.54) between the younger and older children were not different. Conclusion: Female gender, and bladder and bowel dysfunction were associated to febrile UTI in older children. The TPNA febrile UTI guideline imaging recommendation was shown to be applicable in both younger and older children. Keywords: Clinical characteristics; Febrile urinary tract infection; Thai guideline imaging recommendations; Renal and bladder ultrasound; Voiding cystourethrography

Timing of voiding cystourethrography after febrile urinary tract infection in children: a systematic review

2019 ◽  
Vol 105 (3) ◽  
pp. 264-269 ◽  
Author(s):  
Sara Mazzi ◽  
Katharina Rohner ◽  
Wesley Hayes ◽  
Marcus Weitz
Keyword(s):  
Systematic Review ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Antibiotic Therapy ◽  
Detection Rate ◽  
Vesicoureteric Reflux ◽  
Voiding Cystourethrography ◽  
Febrile Urinary Tract Infection ◽  
Number Of Patients

BackgroundDespite a trend towards early voiding cystourethrography (VCUG) after febrile urinary tract infection (fUTI) in children, clinical guidelines do not comment on the optimal timing and current practice varies considerably.ObjectiveTo assess whether the detection rate of vesicoureteric reflux (VUR) in children depends on the time period of VCUG procedure after onset of antibiotic therapy.MethodsMEDLINE, EMBASE and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language or time restriction (19 November 2018). Inclusion criteria were (1) patients <18 years of age; (2) VCUG performed in patients with fUTI after onset of antibiotic therapy either in the same patient population or in two or more different patient populations within one study at different time periods; and (3) with reported detection rate of VUR. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.ResultsOf 4175 records, nine studies were included (number of patients, n=1745) for the main outcome prevalence of VUR by VCUG <8 days compared with VCUG ≥8 days after onset of antibiotic therapy. Pooled overall prevalence of VUR was not significantly different between the early and the late VCUG groups (risk ratio 0.98, 95% CI 0.81 to 1.19). Prevalence of VUR stratified by grade was not significantly different between the two groups.ConclusionEarly VCUG within 8 days after onset of antibiotic therapy does not affect the prevalence of VUR.Trial registration numberCRD42018117545

scholarly journals Risk of Cancer after Lower Urinary Tract Infection: A Population-Based Cohort Study

2019 ◽  
Vol 16 (3) ◽  
pp. 390 ◽  
Author(s):  
Chia-Hung Huang ◽  
Ying-Hsiang Chou ◽  
Han-Wei Yeh ◽  
Jing-Yang Huang ◽  
Shun-Fa Yang ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Cohort Study ◽  
Urinary Tract ◽  
Urinary Bladder ◽  
Tract Infection ◽  
Lower Urinary Tract ◽  
Population Based ◽  
Control Group ◽  
Lower Urinary Tract Infection ◽  
Lower Urinary

To investigate the association among lower urinary tract infection (UTI), the type and timing of antibiotic usage, and the subsequent risk of developing cancers, especially genitourinary cancers (GUC), in Taiwan. This retrospective population-based cohort study was conducted using 2009–2013 data from the Longitudinal Health Insurance Database. This study enrolled patients who were diagnosed with a UTI between 2010 and 2012. A 1:2 propensity score-matched control population without UTI served as the control group. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. A total of 38,084 patients with UTI were included in the study group, and 76,168 participants without UTI were included in the control group. The result showed a higher hazard ratio of any cancer in both sexes with UTI (for males, adjusted hazard ratio (aHR) = 1.32; 95% confidence interval (CI) = 1.12–1.54; for females, aHR = 1.21; 95% CI = 1.08–1.35). Patients with UTI had a higher probability of developing new GUC than those without UTI. Moreover, the genital organs, kidney, and urinary bladder of men were significantly more affected than those of women with prior UTI. Furthermore, antibiotic treatment for more than 7 days associated the incidence of bladder cancer in men (7–13 days, aHR = 1.23, 95% CI = 0.50–3.02; >14 days, aHR = 2.73, CI = 1.32–5.64). In conclusion, UTI is significantly related to GUC and may serve as an early sign of GUC, especially in the male genital organs, prostate, kidney, and urinary bladder. During UTI treatment, physicians should cautiously prescribe antibiotics to patients.

Safety assessment and diagnostic evaluation of patients undergoing contrast-enhanced urosonography in the setting of vesicoureteral reflux confirmation

2021 ◽  
pp. 1-9
Author(s):  
Constantin A. Marschner ◽  
Vincent Schwarze ◽  
Regina Stredele ◽  
Matthias F. Froelich ◽  
Johannes Rübenthaler ◽  
...  
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Vesicoureteral Reflux ◽  
Sensitivity And Specificity ◽  
Diagnostic Tool ◽  
High Sensitivity ◽  
Upper Urinary Tract ◽  
Clinical Diagnostics ◽  
Voiding Cystourethrography

BACKGROUND: Vesicoureteral reflux (VUR) represents a common pediatric anomaly in children with an upper urinary tract infection (UTI) and is defined as a retrograde flow of urine from the bladder into the upper urinary tract. There are many diagnostic options available, including voiding cystourethrography (VCUG) and contrasted-enhanced urosonography (ceVUS). ceVUS combines a diagnostic tool with a high sensitivity and specificity which, according to previous study results, was even shown to be superior to VCUG. Nevertheless, despite the recommendation of the EFSUMB, the ceVUS has not found a widespread use in clinical diagnostics in Europe yet. MATERIALS AND METHODS: Between 2016 and 2020, 49 patients with a marked female dominance (n = 37) were included. The youngest patient had an age of 5 months, the oldest patient 60 years. The contrast agent used in ceVUS was SonoVue®, a second-generation blood-pool agent. All examinations were performed and interpreted by a single experienced radiologist (EFSUMB Level 3). RESULTS: The 49 patients included in the study showed no adverse effects. 51%of patients (n = 26) were referred with the initial diagnosis of suspected VUR, while 49%of patients (n = 23) came for follow-up examination or to rule out recurrence of VUR. The vast majority had at least one febrile urinary tract infection in their recent medical history (n = 45; 91,8%). CONCLUSION: ceVUS is an examination method with a low risk profile which represents with its high sensitivity and specificity an excellent diagnostic tool in the evaluation of vesicoureteral reflux, especially in consideration of a generally very young patient cohort.

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