Question

• Does VCUG done at less than 7 days from diagnosis of febrile UTI accurately diagnose Vesicoureteral Reflux (VUR) as compared to waiting 4-6 weeks?

Clinical Bottom Lines

1. The VCUG does not need to be delayed 4-6 weeks.
   
2. Early VCUG (at less than 7 days) may be considered if patient risks being lost to follow up.
   
3. Although it lacks strong evidence, the AAP guideline² (VCUG to be done 'at earliest convenience' as long as patient no longer infected, with no bladder irritability) is still the best way to go.

Summary of Key Evidence

1. Retrospective study on children (<5 years old) with febrile UTI.¹
   
2. 82 children had a VCUG done at less than 7 days; 17.1% had VUR.
   
3. 80 children had a VCUG done at greater than 7 days; 26.3% had VUR.
   
4. No statistical difference noted in rate of detection of VUR (p=0.219).
   
5. The article suggests that VCUG's done at less than 7 days do not falsely increase the diagnosis of VUR in children with first febrile UTI's.
   
6. This article lacks significant power to support its claims.
   
7. Difficult to describe the validity or importance of this article since it doesn't seem to fit a prognosis study appropriately.
   

Additional Comments

• Studies from the 1960's thought the febrile UTI would exacerbate reflux if present, with increased inflammation or ureteral dilatation.^1,3
  
• Waiting 4-6 weeks would allow the urinary system to "calm down," which was felt to improve the accuracy of diagnosing VUR.^1,3
  
• Further studies need to determine if there is a difference in the long-term outcome between those that are diagnosed early and late.
  

Citation

1. Mahant S, To T, Friedman J. Timing of voiding cystourethrogram in the investigation of urinary tract infections in children. J Pediatr 2001; 139: 568-71.
   
2. American Academy of Pediatrics. Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999; 103:843-52.
   
3. McDonald A, Scranton M, Gillespie R, Mahajan V, Edwards GA. Voiding cystourethrograms and urinary tract infections: how long to wait? Pediatrics 2000;105:e50.

CAT Author: Fabian Salinas, MD

CAT Appraisers: John G. Frohna, MD

Date appraised: May 12, 2003