Voiding Cystourethrography - Do We Over-Do IT

Background: Voiding cistourethrography (VCUG) is the commonly used modality in the setting of (febrile, upper, or neonatal) urinary tract unfection – not in the primary assessment but after the infection has been treated, to assess for vesicoureteric reflux, but also in diagnostics of other urogenital anomalies.

Objective: To determine if there is a way to lower the number of VCUG-s performed.

Methods: Retrospective study was conducted with approval of the Ethics Review Board using clinical data of the patients who underwent VCUG over the period of 12 months. Indicators (age of the patient, gender, referring specialist – Urologist or Nephrologists and indications for VUCG) were analyzed using Chi-square (Table 1), Fisher’s exact and Mann-Whitney test. Possible impact of the above mentioned indicators on the result of the VCUG were analyzed using logistic regressive analysis.

Results: Total of 197 VCUGs were analyzed. Mann-Whitney U test did not show statistically significant age difference between the patients with normal and pathologic findings on VCUG (Z=-0.415, p=0.678, median age in patients with normal finding was 3 years and in patients with pathologic findings on VCUG was 2.5 years). Chi-square test showed that patients with single urinary infection and other indications have a higher chance of normal result on VCUG (0.041 and 0.011 respectively) unlike patients with repeated VCUG who have a higher chance of pathologic findings (0.000). Logistic regressive analysis showed that patients whose referring specialist was urologist had 2.06 times higher chance for having pathologic finding on VCUG (b=-0.810, p=0.007, odds ratio=0.445) compared to those referred by Nephrologist.

Conclusion: At our Institute Pediatric Urologists indicate VCUG more cautiously compared to the Pediatric Nephrologists. By avoiding VCUG after single urinary tract infection and for other indications we could reduce the number of VCUGs performed.