Pediatric voiding cystourethrography: an essential examination for urologists but a terrible experience for children

“This invasive procedure imposes a significant burden on children and their parents.”

“In some countries, including Japan, VCUG is mainly carried out by young urologists, but if they are inexperienced, patients experience more distress and anxiety.”

“VCUG is painful and unpleasant, with urethral catheterization and voluntary voiding in public. After catheterization and filling the bladder with contrast medium, the patient must void in front of the X-ray camera, which causes anxiety for patients and families. More than half the children undergoing VCUG remember it as worse than VUR surgery. This is an extremely humiliating experience for toilet-trained children, because they are educated to void in the restroom.”

“Children’s developing tissues and organs are approximately 10-fold more sensitive to ionizing radiation than adults, and mean risks for hereditary effects and cancer after VCUG during childhood have been estimated at 15 per million and 125 per million, respectively. Thus, radiation risks associated with VCUGs are NOT negligible.”

“Performance of VCUG should be reserved for those occasions when the results would affect VUR management to determine the requirement for surgical intervention.”