PATTERNS OF INTEGRATION AND CLINICAL-VALUE OF VOIDING CYSTOURETHROGRAPHY IN THE WORK-UP OF URINARY-TRACT INFECTION IN CHILDREN

Objective: To evaluate the patterns of integration and the clinical va lue of voiding cystourethrography (VCUG) in the imaging work-up of chi ldren with urinary tract infection (UTI). Methods. We reviewed the med ical records of a consecutive sample of 80 children that underwent VCU G as part of routine investigation for UTI. We assessed the following: the appropriateness of integration of VCUG in the patient work-up as determined by the presence or absence of a valid indication for VCUG i n the specific clinical situation encountered, the correct timing of t he examination and interpretation of its result; the change in clinica l management initiated by the result of the test, and the reassurance conferred to the clinician. Results: Sixty-nine percent of the VCUG ex aminations were judged appropriately integrated, 14% of the examinatio ns inappropriately integrated, while for the rest of the patients (17% ) the appropriateness of integration of the test was rated as unclear. The change in patient management attributable to the VCUG result coul d be categorized as: no change (15%); decision to end the imaging inve stigation of the patient (39%); decision to end all investigations, an d prophylactic or therapeutic interventions (17%); decision to discont inue chemoprophylaxis (1%); decision to end the imaging investigation and introduce chemoprophylaxis and follow-up for bacteriuria (5%); dec ision to continue the imaging investigation and introduce chemoprophyl axis and follow-up for bacteriuria (15%), and decision to operate or h elp in planning the surgical treatment required (8%). Conclusion: The findings show the need for an increased effort to minimize overuse of VCUG in pediatric UTI. Future interventions should focus on issues of clinical efficacy of the method that may have not been emphasized suff iciently.