The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection

Abstract

Objective: Physicians often defer obtaining a voiding cystourethrogram (VCUG) after the diagnosis of urinary tract infection (UTI) due to concerns regarding increased health risks and inflated rates of vesicoureteral reflux (VUR). This study examines the health risks and accuracy of VCUG testing after diagnosis of a febrile UTI.

Patients and methods: A retrospective review was conducted of children aged 0-18 years admitted to Nationwide Children's Hospital with a febrile UTI in 1995-2000. Children were divided into two cohorts - those who had a VCUG performed within 1 week of diagnosis (early VCUG cohort) and those who had a VCUG performed more than 1 week after diagnosis (late VCUG cohort). All children were followed for an additional 5 years after hospital discharge.

Results: The incidence and severity of VUR were similar in patients that underwent early and late VCUG testing. Patients who underwent early VCUG testing showed no sign of worsening illness after the test was performed. During the 5-year follow up, these patients did not have higher rates of return emergency department visits or hospital readmission compared to those who received late VCUG testing.

Conclusions: The rate of VUR detection does not increase with early VCUG testing. Early VCUG testing does not lead to increased risk of bacterial dissemination or urosepsis.

Figure 1

Scatter graph comparing maximum temperatures of inpatients over 12 h before and after VCUG testing. Differences in median maximal temperature between the 12 h prior to the VCUG (98.6 °F, range 96.4–103.5 °F) and 12 h after the VCUG (98.5 °F, range 96.6–102.8 °F) were not statistically significant (P = 0.492).