title: Role of positional instillation of contrast cystography in the algorithm for evaluating children with confirmed pyelonephritis.
abstract: OBJECTIVE
  To assess the utility of positional instillation of contrast (PIC) cystography in detecting vesicoureteral reflux (VUR) in patients with renal scarring from recurrent febrile urinary tract infections that standard voiding cystourethrography and nuclear cystogram imaging failed to reveal.
  
  
  METHODS
  Between June 2004 and November 2004, a total of 5 pediatric patients with recurrent febrile urinary tract infections and radiologic evidence of upper tract involvement were examined with PIC cystography. All patients had at least one previous negative standard reflux study (voiding cystourethrography or nuclear cystography).
  
  
  RESULTS
  All 5 patients showed VUR on PIC cystography. Unilateral reflux was detected in 3 patients, and 2 patients had bilateral VUR.
  
  
  CONCLUSIONS
  The PIC cystogram should be integrated into the algorithm for diagnosing patients with recurrent febrile urinary tract infection, who do not exhibit VUR on standard imaging modalities. The morbidity associated with undiagnosed VUR, as demonstrated by this group of patients, suggests that permanent renal damage may be prevented by early diagnosis and treatment.
authors.affiliation: Department of Urology, Northeastern Ohio University College of Medicine, Children's Hospital Medical Center of Akron, Akron, Ohio, USA. tareen@medicine.nodak.edu
authors.forename: Basir U
authors.initials: BU
authors.lastname: Tareen
authors.forename: Don
authors.initials: D
authors.lastname: Bui
authors.forename: Daniel R
authors.initials: DR
authors.lastname: McMahon
authors.forename: Phillip F
authors.initials: PF
authors.lastname: Nasrallah
mesh_terms: D020341:Absorbable Implants; D000283:Administration, Intravesical; D000293:Adolescent; D000465:Algorithms; D001672:Biocompatible Materials / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D003911:Dextrans / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage; D008297:Male; D011187:Posture; D011704:Pyelonephritis / Q000000981:diagnostic imaging / Q000209:etiology*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D004113:Succimer; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000150:complications; D014567:Urography / Q000379:methods*; D013520:Urologic Surgical Procedures; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy
chemical_list: D001672:Biocompatible Materials; D003287:Contrast Media; D003911:Dextrans; D019275:Radiopharmaceuticals; C094535:deflux; D006820:Hyaluronic Acid; D004113:Succimer