title: Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection?
abstract: OBJECTIVE
  The aim of this study was to estimate the value of identifying vesicoureteral reflux (VUR) on a voiding cystourethrogram (VCUG) and the benefit of VUR management according to imaging strategies at the first febrile urinary tract infection (UTI).
  
  
  METHODS
  Children aged 1-144 months (n = 618) with the first febrile UTI admitted at our hospital from 2000 to 2009 were enrolled. In all patients, renal sonogram (US), (99m) Tc-dimercaptosuccinic acid (DMSA) renal scanning and VCUG were performed. Retrospective analyses per patient and per renal unit were performed.
  
  
  RESULTS
  Abnormal US or DMSA scans had a sensitivity of 100% and a negative predictive value (NPV) of 100% to detect high-grade reflux. In hydronephrotic kidneys, DMSA scanning had a sensitivity of 88.2% and a NPV of 97.1% to detect high-grade reflux.
  
  
  CONCLUSIONS
  Routine VCUG is not required after the first febrile UTI in patients with normal US or normal DMSA scan. Even if the US reveals hydronephrosis, routine VCUG is not necessary if the DMSA findings are normal. It is recommended that children who did not receive both a DMSA scan and VCUG after the first febrile UTI should be followed up over the long term.
authors: Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. naesusana@yahoo.co.kr
authors: Jun Ho
authors: JH
authors: Lee
authors: Moon Kyu
authors: MK
authors: Kim
authors: Sung Eun
authors: SE
authors: Park
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000209:etiology*; D007223:Infant; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000000981:diagnostic imaging / Q000209:etiology*; D011859:Radiography; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging*; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000209:etiology*; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid