title: History of recurrent urinary tract infection is not predictive of abnormality on voiding cystourethrogram.
abstract: OBJECTIVE
  The American Academy of Pediatrics recently recommended against routine voiding cystourethrograms (VCUGs) in children 2 to 24 months with initial febrile UTI, raising concern for delayed diagnosis and increased risk of UTI-related renal damage from vesicoureteral reflux (VUR). We assessed factors potentially associated with higher likelihood of abnormal VCUG, including UTI recurrence, which could allow for more judicious test utilization.
  
  
  METHODS
  We retrospectively reviewed all initial VCUGs performed at Children's Hospital of Michigan between January and June, 2010. History of recurrent UTI was ascertained by evidence of two or more prior positive cultures or history of "recurrent UTI" on VCUG requisition. Outcomes assessed included rates of VUR or any urologic abnormality on VCUG.
  
  
  RESULTS
  Two hundred and sixty-two patients met inclusion criteria. VUR was detected in 21.3 %, urologic abnormality including VUR in 27.4 %. Degree of bladder distension, department of referring physician, study indication, positive documented urine culture, and history of recurrent UTI or UTI and other abnormality were all not associated with increased likelihood of VUR or any urologic abnormality on VCUG.
  
  
  CONCLUSIONS
  VUR and VCUG abnormality are no more likely when performed after recurrent UTI or for UTI plus other abnormality. This reasons against postponing VCUG until after UTI recurrence, as positive findings are no more likely in this setting.
authors.affiliation: Department of Urology, Henry Ford Hospital, 2799 W. Grand Blvd, K-9 Urology, Detroit, MI 48202, USA. afriedm1@hfhs.org
authors.forename: Ariella A
authors.initials: AA
authors.lastname: Friedman
authors.forename: Cortney
authors.initials: C
authors.lastname: Wolfe-Christensen
authors.forename: Amanda
authors.initials: A
authors.lastname: Toffoli
authors.forename: David E
authors.initials: DE
authors.lastname: Hochsztein
authors.forename: Jack S
authors.initials: JS
authors.lastname: Elder
authors.forename: Yegappan
authors.initials: Y
authors.lastname: Lakshmanan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D014554:Urination / Q000502:physiology*; D014567:Urography / Q000379:methods*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology
references.citation: Pediatr Nephrol. 1996 Apr;10(2):139-42
references.pmid: 8703696
references.citation: Pediatrics. 2010 Dec;126(6):1084-91
references.pmid: 21059720
references.citation: Pediatr Nephrol. 2005 Oct;20(10):1449-52
references.pmid: 16047224
references.citation: Adv Urol. 2011;2011:397618
references.pmid: 21274426
references.citation: Pediatrics. 2011 Sep;128(3):595-610
references.pmid: 21873693
references.citation: J Urol. 2010 Oct;184(4 Suppl):1703-9
references.pmid: 20728131
references.citation: Arch Dis Child. 2005 Jul;90(7):733-6
references.pmid: 15970618
references.citation: Issues Compr Pediatr Nurs. 1998 Apr-Jun;21(2):85-96
references.pmid: 10196917
references.citation: Pediatr Surg Int. 2011 Apr;27(4):337-46
references.pmid: 21305381
references.citation: Radiology. 2008 Dec;249(3):1002-9
references.pmid: 18941159
references.citation: J Urol. 1983 Jun;129(6):1190-4
references.pmid: 6854796
references.citation: Pediatr Nephrol. 2010 Aug;25(8):1463-9
references.pmid: 20467791
references.citation: Pediatr Nephrol. 1987 Oct;1(4):647-56
references.pmid: 3153346
references.citation: J Pediatr. 2009 Jun;154(6):797-802
references.pmid: 19230904
references.citation: Pediatr Nephrol. 2009 Oct;24(10):2059-63
references.pmid: 19588169
references.citation: Eur J Pediatr. 2012 Nov;171(11):1605-10
references.pmid: 22735979
references.citation: Pediatr Nephrol. 2011 Nov;26(11):1967-76
references.pmid: 21409431
references.citation: N Engl J Med. 2003 Jan 16;348(3):195-202
references.pmid: 12529459
references.citation: Arch Dis Child. 2002 Jun;86(6):419-20
references.pmid: 12023172
references.citation: Acta Paediatr. 2012 Mar;101(3):e105-9
references.pmid: 22040289
references.citation: J Hypertens. 2000 Apr;18(4):485-91
references.pmid: 10779101
references.citation: Pediatr Nephrol. 2012 Apr;27(4):611-5
references.pmid: 22234625
references.citation: J Urol. 2010 Mar;183(3):1146-50
references.pmid: 20096887
references.citation: BMJ. 1989 Sep 16;299(6701):703-6
references.pmid: 2508881
references.citation: Acta Paediatr. 1998 Feb;87(2):175-9
references.pmid: 9512204