Too many cystograms in the investigation of urinary tract infection in children?

We report on 62 children referred for a first micturating cystourethrogram (MCU) and intravenous urogram (IVU) because of suspected or proven urinary tract infection (UTI). The study represents 1 year's experience of a district hospital, but excludes children below the age of 6 months and those with a diagnosis of urinary drainage anomaly. The IVU proved a good predictor of gross vesicoureteric reflux, which affected 11 children, all with suspect IVUs. Lesser grades of reflux can occur in the presence of a normal IVU but are unlikely to damage the kidney. They can be managed by treating symptoms of infection rather than by the need to protect nephrons. In our study a suspect IVU implied a 79% chance of gross reflux, and a normal IVU excluded such reflux. It is suggested that children over 6 months of age with a clinically important infection should be spared an MCU unless the IVU is abnormal, or troublesome infections recur.