The growing role of ultrasonography in evaluating children after urinary tract infection

Abstract

The purpose of this review is to advocate the use of ultrasonography (US) techniques in the work-up of children after a urinary tract infection (UTI). Currently, two major approaches are recognized. The first approach recommends looking for vesicoureteral reflux (VUR) in all children following a UTI. New techniques have been developed where, in the majority of cases, x-ray voiding cystourethrography (VCUG) is first substituted with radionuclide voiding cystography, and finally with echo-enhanced voiding urosonography, and this presented a significant improvement in diminishing the radiation burden on patients; yet there remained the drawback that catheterization is still necessary with all of these techniques. The introduction of catheter-free procedures would be a ‘final solution’, but these are yet to be validated. The second approach recommends screening for scars (mostly using a dimercaptosuccinic acid renal scan), while cystographies (preferably VCUG) are only performed in cases in which renal scarring has been confirmed. It was demonstrated that a dimercaptosuccinic acid renal scan can be safely and efficiently replaced by US, while voiding urosonography can substitute VCUG in children with confirmed scars in whom one believes VUR should be sought. From here on, catheter-free US techniques for VUR detection, although promising a ‘final solution’, still remain to be validated. In conclusion, regardless of which approach one believes is more appropriate in the management of children following a UTI, it is obvious that both protocols can be sufficiently fulfilled by the use of US techniques. At this time, more studies are needed to properly validate the latest noninvasive (catheter-free) US techniques for VUR detection.