From the Guidelines
Voiding Cystourethrogram (VCUG) is not contraindicated in urinary tract infections (UTIs) or other conditions, but it is usually performed after resolution of acute symptoms to assess for underlying anatomic causes. The decision to perform a VCUG should be based on the individual patient's condition and the potential benefits of the procedure in guiding treatment decisions. According to the most recent and highest quality study 1, VCUG is recommended in patients with certain conditions, such as bilateral high-grade hydronephrosis, duplex kidneys with hydronephrosis, a solitary kidney with hydronephrosis, ureteric dilatation, abnormal bladders, and a history of febrile UTIs. Some key points to consider when deciding whether to perform a VCUG include:
- The patient's overall health and development
- The presence of febrile UTIs or other symptoms
- The results of other diagnostic tests, such as ultrasound or DMSA scans
- The potential risks and benefits of the procedure, including radiation exposure and catheterization. It is essential to weigh these factors and consider the latest guidelines and evidence when making a decision about whether to perform a VCUG in a patient with a UTI or other condition. The procedure should be performed by experienced personnel who can minimize radiation exposure and discomfort, and appropriate antibiotic prophylaxis should be used to prevent urinary tract infections following catheterization, especially in patients with known urinary tract anomalies 1. In general, the diagnostic benefits of VCUG typically outweigh the risks when evaluating patients with suspected urinary tract anomalies or other conditions that may benefit from the procedure.
From the Research
Voiding Cystourethrogram (VCUG) Contraindications
- VCUG is not absolutely contraindicated in urinary tract infections (UTIs) or other conditions, but its use should be considered carefully based on individual patient circumstances 2, 3, 4, 5, 6
- The decision to perform VCUG in patients with UTIs should be based on the presence of other risk factors, such as vesicoureteral reflux (VUR) or renal scarring 2, 3, 6
Timing of VCUG Performance
- Performing VCUG early after UTI does not influence the detection rate, severity of VUR, or risk of secondary infection, and may shorten the period of prophylactic use and increase the performance rate of VCUG 5
- The traditional recommendation of performing VCUG 3-6 weeks after the diagnosis of UTI should be reevaluated 5
Use of VCUG in Specific Patient Populations
- In male neonates with UTI, VCUG and ultrasound (US) should be performed routinely after the initial infection, and renal scan should be reserved for cases with suspected renal parenchymal damage or VUR grade 3 and above 6
- In children with UTI, US alone may be sufficient for imaging the urinary tract, and VCUG should be used only after additional indications 3