Reassessing the Use of VCUG in Pediatric UTIs: Are We Overusing an Invasive Diagnostic Tool?

Background/

Objective

Voiding cystourethrography is the gold-standard diagnostic tool for detecting vesicoureteral reflux and is commonly requested by pediatricians, pediatric nephrologists, emergency pediatricians, and pediatric urologists. However, VCUG is invasive, exposes patients to radiation, and carries a risk of iatrogenic urinary tract infection (UTI). This study aimed to assess the correlation between VCUG findings and factors such as age, gender, referring specialist, and clinical indication for the procedure to identify opportunities to reduce unnecessary VCUG examinations.

Methods

A retrospective analysis of 197 pediatric patients who underwent VCUG over 12 months at the Institute for Child and Youth Health Care of Vojvodina was conducted.

Results

The Mann-Whitney U test showed no statistically significant age difference between patients with normal (median: 2.5 years) and pathological (median: 3 years) VCUG findings (Z = -0.415, p = 0.678). The chi-square test showed that patients with a single urinary tract infection (10 patients) and other clinical indications (24 patients) had a higher chance of normal VCUG findings (0.041 and 0.011, respectively). Binary logistic regression analysis showed that patients referred by pediatric urologists were 2.06 times more likely to have pathological VCUG findings than those referred by pediatric nephrologists (p = 0.013, OR = 2.059; 95%CI: 0.166-3.634). Regarding clinical indications, the chance that VCUG findings would be normal was 2.7 times higher in patients with other indications than in patients with recurrent UTIs (p = 0.038, OR = 2.729; 95% CI: 1.055-7.059).

Conclusions

Pediatric urologists tend to refer patients for VCUG more selectively than pediatric nephrologists. Avoiding VCUG in cases of a single UTI or non-specific clinical indications could significantly reduce the number of unnecessary procedures, minimizing patient exposure to radiation and potential complications.