Imaging after UTI—always a VCUG?

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The appropriate imaging studies (if any) after an initial urinary tract infection continue to be a topic of great controversy. It is likely that some good evidence-based guidelines will be forthcoming, but currently, we are still in the mode of accumulating data.

A study by Lee et al in the current issue of The Journal is a nice contribution to the data acquisition process. These Taiwanese investigators examined imaging studies performed on 699 children between 2 months and 2 years of age who had been treated for UTI and had undergone an imaging trifecta: voiding cystourethrogram (VCUG), renal ultrasound, and renal cortical scan (DMSA). The purpose of the study was to identify children in whom VCUG, the most invasive and potentially problematic of the three studies, could be avoided. The take-home message was that ultrasound and DMSA had a sensitivity of 83% and a negative predictive value of 92% for identifying children with high-grade reflux.

Although the results of this study by themselves may not provide definitive guidelines, it is nicely done work such as this that should inform the development of such guidelines.