Evaluation of Timing of Voiding Cystourethrogram after Urinary Tract Infection

PURPOSE: Urinary tract infection is a common problem in children. To evaluate for reflux most authorities recommend a voiding cystourethrogram 3 to 6 weeks after the first urinary tract infection. But during the 3 to 6 weeks interval, patients may fail to show up for the scheduled VCUG and thus risk for loss of follow up. We analyzed patient's records to evaluate whether the timing of VCUG after UTI influenced the prevalence or severity of VUR. METHODS: We retrospectively reviewed 213 children diagnosed with UTI from March 1997 to December 2000. These children were divided into 2 groups according to whether they had VCUG scheduled to be performed either within 1 weeks after the diagnosis of UTI (Group A) or later than 1 week after the diagnosis(Group B). We compared the presence and severity of reflux in the 2 groups. RESULTS: Reflux was present in 19% of the patients studied within 1 week after UTI and in 18% of those studied after 1 week. This difference was not statistically significant. Whereas 100% of the scheduled VCUGs in the Group A were performed, only 48% of those scheduled in the Group B were performed. This difference is statistically significant. CONCLUSION: Because there was no significant difference between the presence or severity of reflux and timing of VCUG after UTI, we suggest that a hospitalized patient with UTI should have VCUG performed before discharge.

Vesicoureteral Reflux in the Adult Uncomplicated Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: Acute pyelonephritis (APN) is mostly caused by ascending infection. Based on clinical and experimental studies, it is known that APN is caused by bacteria that ascends from the bladder through the ureter to the renal pelvis and parenchyma. Urinary reflux, bacterial virulence factors, and decreased ureteral peristalsis are some of the causes of ascending infection. We have tried to evaluate the significance of reflux in adult uncomplicated APN. MATERIALS AND METHODS: Voiding cystourethrogram (VCUG) was performed in 71 female patients with APN who showed no structural abnormalities on either intravenous urogram or ultrasonogram from April 1998 to May 2000. VCUG was performed at cure phase (29.7+/-9.18 days, 20 patients) in the early days of the study and the date of performing VCUG was shortened gradually to resolved phase (13.8+/-2.13 days, 10 patients), subacute phase (6.60+/-1.84 days, 10 patients), and acute phase (2.42+/-0.51 days, 31 patients). RESULTS: There were only 2 (2.8%) cases with vesicoureteral reflux among 71 female patients with uncomplicated APN. 1 ipsilateral grade 2 reflux was found among the 20 patients who underwent VCUG at cure phase. 1 case with ipsilateral grade 1 reflux was found at resolved phase. Reflux was not found in the groups where study was performed at subacute and acute phase. The cause of infection was found to be E. coli (55 patients, 77.5%), Enterococcus faecalis (3 patients, 4.2%), Klebsiella pneumoniae (2 patients, 2.8%), and S. aureus (1 patients, 1.4%). CONCLUSIONS: These results suggest that reflux may not be a significant factor causing ascending infection that leads to APN. More study on the pathophysiology of ascending infection to the upper urinary tract is warranted.

The value of a voiding cystourethrogram: Single and isolated recurrent urinary tract infection

OBJECTIVE: This study is designed to determine the correlation between a voiding cystourethrogram in children and a single and isolated recurrent urinary tract infection, as well as the most frequent presenting symptom in children yielding a positive resultMATERIALS AND METHODS: One hundred ninety seven (197) children, ages 0-6 years old, diagnosed to have a urinary tract infection based on history, physical examination, urinalysis and urine culture. Group I included those with single and isolated urinary tract infection: Group II, those with recurrent urinary tract infection. All patients in both groups underwent a voiding cystourethrogramRESULTS: Of one hundred ninety-seven (197), sixty-seven (67) of them were assigned to Group I, while one hundred thirty (130) were assigned to Group II. Sixteen (16) out of sixty-seven (67) in Group I (23 percent) and forty-four (44) out of one hundred thirty (130) in Group 2 had a positive VCUG. High grade fever was the most common presenting symptomCONCLUSION: The frequency of a urinary tract infection did not significantly affect positivity with voiding cystourethrogram. However, the presence of high grade fever correlated better with a (+) VCUG. (Author)