Too Many Cystograms in the Investigation of Urinary Tract Infection in Children?

Abstract

Children (62) referred for a first micturating cystourethrogram (MCU) and i.v. urogram (IVU) because of suspected or proven urinary tract infection (UTI). The study repesents 1 yr experience of a district hospital, but excludes children below the age of 6 mo. and those with a diagnosis of urinary drainage anomaly. The IVU proved a good predictor of gross vesicoureteric reflux, which affected 11 children, all with suspect IVU. Lesser grades of reflux can occur in the presence of a normal IVU but are unlikely to damage the kidney. They can be managed by treating symptoms of infection rather than by the need to protect nephrons. A suspect IVU implied a 79% chance of gross reflux, and a normal IVU excluded such reflux. Children > 6 mo. of age with a clinically important infection should be spared an MCU unless the IVU is abnormal, or troublesome infections recur.