title: Multi-institutional experience with PIC cystography--incidence of occult vesicoureteral reflux in children with febrile urinary tract infections.
abstract: OBJECTIVE
  It has been reported that all children with febrile urinary tract infections (FUTIs) and normal voiding cystourethrogram (VCUG) findings show occult reflux (vesicoureteral reflux [VUR]) when examined by cystography performed with positioning of the instillation of contrast at the ureteral orifice (PIC cystography). In this study, we evaluated the reproducibility of this finding using a prospective multi-institutional collaborative examination to determine whether PIC-VUR is as common in such cases as previously shown.
  
  
  METHODS
  From March 2002 to October 2003, four institutions performed PIC cystography consecutively and prospectively in pediatric cases of FUTI (greater than 101 degrees F) who had not shown VUR by conventional VCUG. We correlated the ureteral orifice (UO) configuration and position with the status of PIC-VUR.
  
  
  RESULTS
  PIC cystography was performed in 39 children (31 girls and 8 boys; 75 FUTIs). We identified PIC-VUR in 32 (82%) of 39 children, involving 58 (74%) of 78 ureters. The likelihood of demonstrating PIC-VUR was increased 37-fold if the UO showed a patulous configuration and was increased 9-fold if the UO showed a lateral configuration. PIC-VUR was noted uniformly in UOs showing hydrodistension.
  
  
  CONCLUSIONS
  This multi-institutional registry showed that the incidence of PIC-VUR (82%) in children with FUTI and normal standard VCUG findings is similar to that previously reported. We consider that PIC-VUR likely accounts for the FUTIs.
authors.affiliation: Virginia Urology Children's Center, Richmond, Virginia 23235, USA. jedmondson@uro.com
authors.forename: John D
authors.initials: JD
authors.lastname: Edmondson
authors.forename: Max
authors.initials: M
authors.lastname: Maizels
authors.forename: Seth A
authors.initials: SA
authors.lastname: Alpert
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
authors.forename: Moneer K
authors.initials: MK
authors.lastname: Hanna
authors.forename: Adam C
authors.initials: AC
authors.lastname: Weiser
authors.forename: Paolo
authors.initials: P
authors.lastname: Caione
authors.forename: William E
authors.initials: WE
authors.lastname: Kaplan
authors.forename: Earl Y
authors.initials: EY
authors.lastname: Cheng
authors.forename: John T B
authors.initials: JT
authors.lastname: Houston
mesh_terms: D000283:Administration, Intravesical; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D003558:Cystoscopy; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D014513:Ureter; D014552:Urinary Tract Infections / Q000150:complications*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine