Cyclic cystography: Diagnostic yield in selected pediatric populations

PURPOSE: To test the hypothesis that the diagnostic yield of cyclic cystogr aphy is related to the prevalence of vesicoureteral reflux (VUR) in the pop ulation being evaluated. MATERIALS AND METHODS: Two groups of children were examined prospectively: 124 with severe urinary tract infection, defined as patient hospitalization or a maximum temperature greater than 39.5 degrees C, and 135 with previou sly diagnosed VUR. Nuclear cystography was performed in 249 patients, and f luoroscopic cystography was performed in 10. If VUR was not seen during the first cycle of bladder filling and voiding, a second cycle was performed. RESULTS: VUR was present during cycle 1 in 40 (32%) of 124 patients with se vere urinary tract infection and 90 (67%) of 135 children in the VUR follow -up group (P <.001). VUR was demonstrated during cycle 2 in seven (9%) of 7 6 of the severe urinary tract infection group and eight (24%) of 34 of the VUR follow-up group (P =.045). Of 15 patients with VUR during cycle 2, two had grade III VUR and 13 had grade I or II VUR. CONCLUSION: The second cycle of cyclic cystography has a higher diagnostic yield in patients undergoing VUR follow-up than in patients with severe uri nary tract infection. The decision to perform a second cycle of bladder fil ling and voiding should take into account the pretest probability of VUR in the child being examined.