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Urinary and Genital Disorders (Children)

2yr old 2nd UTI Does She Need VCUG

07/08/2010

Question:

My NON-pottytrained 2yr old had her 1st UTI about 6 months ago. No fever, but foul smelling urine with painful urination. Her pediatrician strongly recommended a renal ultrasound and vcug. We agreed to the US (which was neg) but declined the vcug (I`m an xray tech and have seen first hand how traumatic they can be). She has now been diagnosed with a 2nd UTI. No fever, same symptoms as before. I really would like to avoid the vcug. Is it really necessary if no fever is present? Our pediatrician is pressuring us and is even using scare tactics! I just want to make the right decision for my child.

Answer:

Views are changing on the need for a VCUG. Since there was no fever with the UTI, it is an indication that she had a bladder infection (cystitis). There is no need for a VCUG. It will not add any useful information, assuming that her kidneys were similar in size and had no irregularity of the kidney outline. Even if she had had a UTI with fever, suggestive of a kidney infection, some would argue that a VCUG is unnecessary, given a normal kidney US, unless it was her second UTI.

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Response by:

Jack S Elder, MD, FACS, FAAP Jack S Elder, MD, FACS, FAAP
Clinical Professor of Urology
School of Medicine
Case Western Reserve University