VCUG Alternatives

Most hospitals don’t disclose VCUG alternatives, leaving parents in the dark about their child's treatment options. Many providers stress VCUG as the best and only way to diagnose VUR effectively. Some physicians even advocate against safe and available alternative measures of care that may be appropriate and beneficial for some patients. However, there are alternatives to the gold-standard VCUG, including a radiation-free exam with an equal or higher diagnostic value.

What Is ceVUS?

The gold-standard VCUG has persisted unchanged since the 1960s. However, there are alternative diagnostic measures available. Recently, ceVUS ("contrast-enhanced voiding urosonography") has gained prominence as a safe and effective diagnostic test for VUR.

ceVUS is performed similarly to a VCUG with a few key differences:

Radiation-free. Unlike VCUG, ceVUS is completely radiation-free, allowing parents to remain in the room and support their child instead of waiting behind walls or barriers.
Improved comfort. Children are able to void sitting in an upright natural position.
More affordable. On average, ceVUS exams cost parents hundreds of dollars less than VCUG exams.
Equal or superior diagnostic value. Research shows that ceVUS has an equal or greater diagnostic value than VCUG.

Additional Alternatives to VCUG

Below are some additional alternatives to VCUG:

Computed Tomography (CT) Urogram

A CT urogram is an advanced imaging technique that uses X-rays to create cross-sectional images of the urinary tract. An intravenous (IV) line is placed into a vein in the hand or arm, through which the X-ray dye will be injected. While CT urography cannot dynamically assess urine flow, it can identify urinary tract abnormalities and signs of VUR, making it a suitable alternative in some scenarios.

Radiation amount: Significantly higher than VCUG.
Diagnostic value: Excellent for high-resolution, comprehensive imaging.
Limitations: Not a primary VUR diagnostic tool and requires more preparation than a VCUG.
Catheterization required? No.
Voiding required? No.

DMSA Renogram (Dimercaptosuccinic Acid Renogram)

The DMSA renogram is invaluable for assessing kidney health, including scarring or damage from recurrent UTIs or VUR. Unlike a VCUG, the DMSA scan doesn't require the child to void or experience invasive catheterization during the test. It uses nuclear medicine imaging with a radioactive tracer injected intravenously.

Radiation: Lower than VCUG.
Diagnostic value: Excellent detailed imaging of kidney function/renal scarring.
Limitations: Does not directly show VUR.
Catheterization required? No.
Voiding required? No.

MAG3 Renal Scan

The MAG3 renal scan evaluates kidney function, drainage, and potential obstructions. A radioactive tracer called MAG3 (Mercaptoacetyltriglycine) is injected into the bloodstream through an IV. A catheter may be necessary to keep the bladder empty during the scan.

Radiation: Lower than VCUG.
Diagnostic value: Excellent detailed imaging of kidney function/drainage.
Limitations: Does not directly visualize VUR.
Catheterization required? Possibly.
Voiding required? No.