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Wednesday, April 23, 2014
Urinary and Genital Disorders (Children)
Does my toddler really need a VCUG?
My son had a urinary tract infection about a year ago, when he was about two years and two months old. He had recently been potty trained. He also was constipated for a couple of months because he did not like to poop in the toilet. The doctor recommended an ultrasound and a VCUG. We had the ultrasound done and the results were normal. I did not take him to do the VCUG because it was going to be invasive, too uncomfortable, and too terrifying for my son (who really hates to be in those type of situations), especially since I didn`t think anything anatomical had caused his UTI. He had never had a UTI before that incident, and he has not had one in the past 12 months. However, my doctor is still pushing me to have it done. In addition, a routine urine exam during his third year visit turned out normal. He is now three years and four months old.
So, my question is: If my son has not had a UTI in over a year, does he still really need to have a VCUG, or is this a situation in which it not really necessary? Thank you for your time and expertise.
There are a few considerations. UTIs can be divided into bladder infections (burning, frequency, incontinence, blood in the urine, malodorous urine) and kidney infections (back pain, fever, abdominal pain, occasionally nausea and vomiting). Repeated kidney infections can cause kidney damage. Boys who are uncircumcised are at greater risk for a bladder infection than boys who are circumcised, and sometimes the urine sample becomes contaminated by the foreskin.
The VCUG primarily is intended to identify individuals who have urinary reflux, which predisposes to kidney infection. If the infection was characteristic of a kidney infection, it would be a good idea to get the VCUG. In some centers, the test can be performed with mild sedation. On the other hand, if the infection involved the bladder, then I would not recommend getting a VCUG at this time.
Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University