From the Guidelines
Voiding cystourethrogram (VCUG) in pediatric patients is primarily indicated for evaluation of urinary tract infections (UTIs), suspected vesicoureteral reflux (VUR), and urinary tract abnormalities, particularly in infants and children under 2 years of age after their first febrile UTI, as they have a higher risk of underlying VUR 1. The main indications for VCUG in pediatric patients include:
- Infants and children with febrile UTIs, particularly those under 2 years of age after their first febrile UTI
- Children with recurrent UTIs
- Prenatal hydronephrosis that persists postnatally
- Abnormal renal ultrasound findings suggesting obstruction or reflux
- Evaluation of urinary tract anomalies such as posterior urethral valves, ureteroceles, or neurogenic bladder The procedure involves catheterization and filling the bladder with contrast material while taking X-ray images during voiding to visualize the urinary tract anatomy and detect reflux of urine from the bladder back into the ureters and kidneys. Prior to the procedure, prophylactic antibiotics (typically a single dose of amoxicillin 50 mg/kg or trimethoprim-sulfamethoxazole 5 mg/kg) may be administered to prevent iatrogenic UTIs, as recommended by the American Academy of Pediatrics (AAP) and supported by studies such as the one published in the Journal of the American College of Radiology 1. VCUG is valuable because it can identify conditions requiring surgical intervention or antibiotic prophylaxis, potentially preventing kidney damage and long-term complications such as hypertension or chronic kidney disease, as highlighted in the study published in the European Urology journal 1. It is essential to note that the indications for VCUG may vary depending on the patient's age, medical history, and underlying conditions, and the decision to perform VCUG should be made on a case-by-case basis, taking into account the latest guidelines and evidence-based recommendations, such as those provided by the AAP and the European Association of Urology 1.
From the Research
Indications for Voiding Cystourethrogram (VCUG) in Pediatric Patients
The following are indications for VCUG in pediatric patients:
- Urinary tract infection (UTI), especially recurrent UTI 2, 3, 4, 5, 6
- Fetal or postnatal hydronephrosis 2, 4, 6
- High-risk children with vesicoureteral reflux (VUR) 2
- Abnormalities found on acute dimercaptosuccinic acid (DMSA) scan and ultrasound (US) 4, 5, 6
- Signs of renal hypodysplasia, cyclic dilatation of pelvicaliceal system, hydroureter, acute pyelonephritis on renal ultrasound scanning or DMSA scanning 5, 6
Specific Conditions
- Recurrent UTI: VCUG is indicated to assess for VUR, especially in children under 1 year of age 2
- Fetal or postnatal hydronephrosis: VCUG is indicated to assess for VUR and other urologic abnormalities 2, 4
- High-grade VUR: VCUG is indicated to confirm the diagnosis and assess the severity of VUR 4, 5, 6