title: The PIC cystogram: its place in the treatment algorithm of recurrent febrile UTIs.
abstract: OBJECTIVE
  A common pediatric dilemma involves management of children with recurrent febrile urinary tract infections (UTIs) who have normal voiding cystourethrograms. Vesicoureteral reflux (VUR) has been demonstrated in such cases by performing a cystogram which positions the instillation of contrast (PIC) at the ureteral orifice. We describe the evidence supporting this diagnostic test.
  
  
  METHODS
  The literature was searched to identify and subsequently evaluate all studies investigating PIC cystography.
  
  
  RESULTS
  In patients with febrile UTIs and negative VCUGs, the PIC cystogram has been demonstrated to identify occult reflux (PIC-VUR). When identified and treated, these patients have a significant reduction in the incidence of febrile UTIs.
  
  
  CONCLUSIONS
  Although the current literature on PIC cystography is limited, it appears to be a clinically useful test in a select group of patients with recurrent febrile UTIs, that are not found to have VUR on a conventional VCUG. A prospective randomized trial is underway to further define its role in the treatment algorithm of febrile UTIs.
authors.affiliation: Department of Pediatric Urology, Children's Memorial Hospital, 2300 Children's Plaza, Box 24, Chicago, IL 60614, USA. jhagerty@childrensmemorial.org
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Hagerty
authors.forename: Max
authors.initials: M
authors.lastname: Maizels
authors.forename: Earl Y
authors.initials: EY
authors.lastname: Cheng