Infantile urinary tract infection and timing of micturating cystourethrogram

Culture-positive urinary tract infection following micturating cystourethrogram in children

Objective

To determine the incidence of culture-positive urinary tract infection (UTI) after micturating cystourethrogram (MCUG). We further wanted to identify risk factors for developing a culture-positive UTI following MCUG.

Methods

A retrospective review of the available medical records of 500 paediatric patients who underwent MCUG in Perth, Western Australia was performed.

Results

Seven (1.4%) patients comprised of four females and three males developed a febrile, culture-positive UTI within 14 days following MCUG. Significant association was found for female patients, patients with neurogenic bladder, and patients with previous culture-positive UTI as developing a culture-positive UTI following MCUG. Multivariate logistic regression determined that patients were more likely to develop culture-positive UTI within 14 days following MCUG if they had a known history of UTI (odds ratio: 5.0, 95% confidence interval: 1.5–17.3, p=0.010) or had a neurogenic bladder (odds ratio: 4.2, 95% confidence interval: 1.0–17.9, p=0.049).

Conclusion

The incidence of patients who developed a febrile, culture-positive UTI following MCUG was low at 1.4%. Statistically significant and independent associations for the development of culture positive UTI were found in patients with neurogenic bladder and patients with previous culture-positive UTI. Further prospective studies are necessary to determine necessity of prophylactic antibiotics for high-risk patients, e.g., patients with neurogenic bladder or previous culture-positive UTI.

Cyclic Direct Radionuclide Cystography in the Diagnosis and Characterization of Vesicoureteral Reflux in Children and Adults

PURPOSE

To investigate the influence of cyclic direct radionuclide cystography (RNC) on the diagnosis of vesicoureteral reflux (VUR) in children and adults.

PATIENTS AND METHODS

A total of 362 examinations were performed in patients with a mean age of 15.8 ± 17.2 years (2 months to 76.4 years, 89.5% female). The examinations were divided into 3 groups of age: A, younger than 5 years; B, 5 years and younger than 14 years; and C, older than 14 years. Repeated cycles of bladder filling without removal of the catheter were performed.

RESULTS

VUR was diagnosed in 21% of patients based on the first cycle, 5.5% in the second cycle, and 2.5% only in the third cycle. Most examinations showing VUR corresponded to grade II. Reflux occurred in only the filling phase in 10%, only the voiding phase in 27%, and both phases in 63% of patients. There was a higher incidence of reflux in groups A and B than group C after the first cycle. The second cycle was equally effective in diagnosing VUR in all 3 groups. In group A, the third cycle was more effective compared to the other groups.

CONCLUSIONS

Performing a second and a third cycle in RNC yielded an additional VUR diagnosis of 35.7%, as compared to performing only 1 cycle. The second cycle showed efficacy in all the groups, whereas the third cycle diagnosed more VUR only in group A. These results confirmed the importance of performing additional cycles in RNC for VUR diagnosis, both in children and adults.

[Vesicoureteral reflux: diagnostics and therapy]

The current management of vesicoureteral reflux (VUR) remains controversial. Recent well thought-out randomized studies on VUR in children have led to a debate on diagnostic and therapeutic algorithms. Individual parameters, such as age, gender, clinical course, renal function and scars, dysfunctional elimination syndrome and last but not least the compliance of the parents have gained in importance. Regarding recent data this article gives a summary of diagnostic steps and therapeutic management of VUR.