Urinary tract infection in children: A narrative review of clinical practice guidelines

2023

“Febrile infants with UTI should undergo RBUS [renal and bladder ultrasound]. VCUG should not be performed routinely after the first febrile UTI; VCUG is indicated if RBUS reveals hydronephrosis, scarring, high-grade VUR, or obstructive uropathy as well as atypical or complex circumstances.”
“VCUG was recommended routinely for children between 2 months and 2 years but not anymore.

This study looks at the guidelines concerning UTIs and demonstrates different places having different guidelines. For example:

“VCUG [is] not routinely recommended after first UTI.”
“VCUG is recommended after first UTI or abnormal RBUS or if the bacterial organism other that E. coli.”
“Voiding cystourethrography (VCUG)/micturating cystourethrogram is an invasive study that is still considered the gold standard for excluding or confirming VUR and for assessing the degree of VUR. It should be performed after the first febrile UTI if the ultrasound suggests either high-grade VUR or obstructive uropathy. Furthermore, it is indicated after a second episode of febrile UTI, atypical and recurrent infections in children <2 years of age and in older children, if there is abnormal voiding, which needs to be evaluated for voiding dysfunction with postvoid residual test and referral to urology before they have a VCUG."
"Likewise, it is indicated if hydronephrosis or thick bladder wall was found on RBUS, non-E. coli infection or family history of VUR were noted. The concept of limiting indications for VCUG and dimercaptosuccinic acid (DMSA) scanning is due to significant radiation exposure, catheter risk-induced UTI, stress for young patients and their parents, and considering the cost of imaging techniques.”
“Where accessible, a nuclear cystogram (NCG) may be used instead of VCUG to evaluate VUR using radioisotopes. It offers a lesser amount of radiation than VCUG but provides poor anatomical detail for the male urethra, so it may miss posterior urethral valves. Using NCG as the initial test for female VUR investigation and in follow-up studies for both genders is reasonable.”