Voiding cystourethrography practices: experiences in a tertiary pediatric referral hospital

Abstract

Background

Voiding cystourethrography (VCUG) remains the best method to diagnose and to determine vesicoureteral reflux (VUR) grade.

Purpose

To determine necessity and indications of VCUG and to investigate high-grade VUR predictors.

Material and Methods

We retrospectively reviewed data. The patients were sorted into three age groups: 0–12 months; 13–24 months; and above 24 months. Student t-test, Mann–Whitney U test, ANOVA, and Kruskal Wallis test were used to compare the means between groups. Pearson’s correlation test was used for correlation analysis. Risk factors were determined by multivariate regression analysis.

Results

The most common indication for VCUG was recurrent urinary tract infections (UTIs). VCUG revealed VUR in 96 (18.4%) patients, posterior urethral valve (PUV) in 13 (2.5%) patients, and bladder anomalies in 14 (2.6%) patients. Neither sex nor age was statistically significantly associated with presence or grades of VUR. Multivariate analysis showed that a history of recurrent UTI (P = 0.008), a presence of high-grade hydronephrosis (HN) on renal-bladder ultrasound (RBUS) (P = 0.001), and a presence of scarring on dimercaptosuccinic acid renal cortical scintigraphy (DMSA) (P < 0.001) were strongly associated with high-grade VUR. In addition, female sex, renal dysfunction, high-grade VUR, history of recurrent UTIs, and older age at diagnosis were identified as risk factors for renal scarring.

Conclusion

We highlight that the most common indication for VCUG is recurrent UTIs, which is associated with higher renal damage and high-grade VUR. If a VCUG should be considered for children with recurrent UTIs, high-grade HN and renal scaring, which are the predictors of high-grade VUR.