[Urethrocystography in children. Practical considerations of irradiation doses].

OBJECTIVE

Rational use of voiding cystourethrography (VCUG) is imperative, as it is an invasive procedure exposing the child to ionizing radiation and other well documented risks. The objective of this study was to contribute to the achievement of a reduction in the irradiation dose in VCUG.

PATIENTS AND

METHODS

We reviewed the medical records of a consecutive sample of 125 children that underwent VCUG in our hospital between January 1995 and June 1996.

RESULTS

Of the 125 VCUGs, 100 were normal, 13 showed vesicoureteric reflux grade II or higher, and 12 of them presented with other anomalies. The indication for VCUG was febrile UTI in 54 children, hydronephrosis detected prenatally in 12 and other causes in 60 children. It is important to note that children with vesicoureteric reflux presented as febrile UTI or fetal hydronephrosis. The age was significantly lower in the reflux group (p < 0.01). Eleven of the 13 children with vesicoureteric reflux were less than one year of age. Ultrasound anomalies and renal scarring in Tc99 DMSA were seen in a larger proportion in the reflux group. Preliminary X-rays showed anomalies in only 3 of 125 cases.

CONCLUSIONS

1) Vesicoureteric reflux is related to febrile UTI and fetal hydronephrosis. The other indications are questionable. 2) VCGU is not recommended following the first UTI in the evaluation of children 6 years of age or older who have a normal ultrasound and Tc99 DMSA. 3) VCUG could be substituted by a nuclear cystogram in girls who do not have a history of voiding dysfunction. 4) A preliminary X-ray is not justified.