Contemporary Practice Patterns of Voiding Cystourethrography Use at a Large Tertiary Care Center in a Single Payer Health Care System.
Voiding cystourethrogram involves radiation exposure and is invasive. Several guidelines, including the 2011 AAP (American Academy of Pediatrics) guidelines, no longer recommend routine voiding cystourethrogram after the initial urinary tract infection in children. The recent trend in voiding cystourethrogram use remains largely unknown. We examined practice patterns of voiding cystourethrogram use and explored the impact of these guidelines in a single payer system in the past 8 years.



We identified all voiding cystourethrograms performed at a large pediatric referral center between January 2008 and December 2015. Patients 2 to 24 months old who underwent an initial voiding cystourethrogram for the diagnosis of a urinary tract infection in the first 6 months of 2009 and 2014 were identified. Medical records were retrospectively reviewed.



During the study period 8,422 voiding cystourethrograms were performed and the annual number declined over time. In the pre-AAP and post-AAP cohorts 233 and 95 initial voiding cystourethrograms were performed, respectively. While there was no statistically significant difference in the vesicoureteral reflux detection rate between 2009 and 2014 (37.3% vs 43.0%, p = 0.45), there was a threefold increase in high grade vesicoureteral reflux in 2014 (2.6% vs 8.4%, p = 0.03).



A clear trend toward fewer voiding cystourethrograms was noted at our institution. This decrease started before 2011 and cannot be attributed to the AAP guidelines alone. While most detected vesicoureteral reflux remains low grade, there was a greater detection rate of high grade vesicoureteral reflux in 2014 compared to 2009. This may reflect a favorable impact of a more selective approach to obtaining voiding cystourethrograms.
Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Linda C
LC
Lee
Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Armando J
AJ
Lorenzo
Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Rakan
R
Odeh
Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Michelle
M
Falkiner
Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Dawn-Ann
DA
Lebarron
Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Jeffrey
J
Traubici
Department of Radiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Erika
E
Mann
Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Paul R
PR
Bowlin
Division of Urology, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: Martin.koyle@sickkids.ca.
Martin A
MA
Koyle
D000070621:Cystography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D000078337:Procedures and Techniques Utilization / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018855:Single-Payer System; D062606:Tertiary Care Centers; D014521:Urethra / Q000000981:diagnostic imaging*; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging*; D014554:Urination; D014572:Urology / Q000592:standards; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging*
diagnostic imaging; single-payer system; standards; urinary tract infections; vesico-ureteral reflux