Symptomatic urinary tract infections following voiding cystourethrography

Tel Aviv University, Tell Afif, Tel Aviv, Israel
Pediatric Nephrology (Impact Factor: 2.86). 11/2005; 20(10):1449-52. DOI: 10.1007/s00467-005-1942-5
Source: PubMed


The objective of this study was to assess the frequency of symptomatic urinary tract infections (UTIs) following voiding cystourethrography (VCUG) while using prophylactic antibiotics. Medical records of 421 patients who underwent a VCUG during a period of 4 years were reviewed. Three hundred forty-nine had a VCUG following a febrile UTI, and 72 had the test for evaluation of hydronephrosis. All received prophylactic antibiotics and were evaluated within 7-10 days following the VCUG. One hundred seventy-two children (41%) had an abnormal VCUG. Seven of 421 children (1.7%) had symptoms suggestive of UTI. Two had culture negative pyuria; one had Escherichia Coli UTI, and four had Pseudomonas aeruginosa UTI. On multivariate logistic regression analysis, the risk factors contributing to the development of UTI following VCUG were the presence of vesicoureteral reflux (VUR) and its severity (odds ratio [OR] 2.52; 95% confidence interval [CI] 2.24, 2.83, p =0.001; and OR 2.32; 95% CI 2.05,2.62, p =0.04, respectively). The incidence of VCUG-induced UTI in children receiving prophylactic antibiotic therapy is low. There is a relatively high rate of Pseudomonas UTI, especially in children with moderate to severe reflux. We recommend that children with symptoms suggesting a UTI following a VCUG should be treated for Pseudomonas aeruginosa pending culture results.

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    • "VCUG is a radiologic procedure for the evaluation of the bladder and urethra, which is valuable for examining and following-up on a VUR and for helping the prevention of renal damage. Iatrogenic complications associated with VCUG are rare events, but some complications include UTI, allergic reaction after procedure, contact dermatitis, knotting of the urethral catheter, and bladder rupture5-10). In Korea, one study reported that 32.7% of patients with VCUG showed complications such as bladder rupture, dysuria, irritability, and hematuria11). "
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    ABSTRACT: Voiding cystourethrography (VCUG) is a commonly performed diagnostic procedure for the evaluation of vesicoureteral reflux with urinary tract infection or congenital renal diseases in children. The procedure is relatively simple and cost-effective, and complications are very rare. The iatrogenic complication of VCUG range from discomfort, urinary tract infection to bacteremia, as well as bladder rupture. Bladder rupture is a rare complication of VCUG, and only a few cases were reported. Bladder rupture among healthy children during VCUG is an especially uncommon event. Bladder rupture associated with VCUG is usually more common in chronically unused bladders like chronic renal failure. Presented is a case of bladder rupture that occurred during a VCUG in a healthy 9-month-old infant, due to instilled action of dye by high pressure. This injury completely healed after 7 days of operation, and it was confirmed with a postoperative cystography. The patient's bladder volume, underlying disease, velocity of the contrast media instilled, catheter size, and styles of instillation are important factors to prevent bladder rupture during VCUG. Management of bladder rupture should be individualized, but the majority of infants are treated with the operation. In conclusion, bladder rupture is a rare complication, however, delicate attention is needed in order to prevent more dire situations.
    Full-text · Article · May 2012 · Korean Journal of Pediatrics
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    ABSTRACT: This chapter includes certain procedures of pediatric nuclear medicine, namely radionuclide imaging stud-ies for the evaluation of important renal diseases in the pediatric age-group, as well as vesicoureteral re-flux and testicular torsion. Other pediatric procedures are covered in the other chapters. Radionuclide imag-ing of the genitourinary tract in children is extensively requested by pediatricians and pediatric surgeons in order to assess renal function by the aid of quantita-tive analysis as well as by the morphological data gained in these studies. These informative data, along with those provided by ultrasonography and excreto-ry urography, provide physicians with valuable objec-tive criteria for diagnosing and following patients. In neonates, radionuclide studies are much used to eval-uate flank masses such as cystic kidneys, hydrone-phrosis, tumors, and congenital abnormalities, e.g., horseshoe kidney, renal ectopia, absence of a kidney, which are often encountered on antenatal ultrasono-graphic examinations. Older children are frequently examined with radionuclide studies for evaluation of genitourinary tract disorders such as infection, hy-dronephrosis, hydroureteronephrosis, vesicoureteral reflux, hypertension, trauma, tumors, and problems resulting from kidney transplantation.
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