Voiding Cystourethrography - Do We Over-Do It

Background: Voiding cystourethrography is primary used to detect vesico-ureteric reflux and is considered “gold standard” diagnostic examination for this condition. It can be ordered by pediatricians, nephrologists, emergency room pediatricians and urologists. Negative effects of Voiding cystourethrographyinclude its invasiveness, radiation exposure and risk of iatrogenic urinary tract infection. Our aim is to determine if we can reduce the number of voiding cystourethrography examinations performed at our Institute. Methods: Retrospective study was conducted with approval of the Ethical Review Board using clinical data of the patients who underwent voiding cystourethrography over the period of 12 months. Indicators (age of the patient, gender, referring specialist – urologist or nephrologists and indications for voiding cystourethrography) were analyzed using Chi-square, Fisher’s exact and Mann-Whitney test. Possible impact of the above mentioned indicators on the result of the voiding cystourethrography was analyzed using logistic regressive analysis. Results: Total of 197 voiding cystourethrographies were analyzed. Mann-Whitney U test did not show statistically significant age difference between the patients with normal (median age 3 years) and pathologic (median age 2.5 years) findings on voiding cystourethrography (Z=-0.415, p=0.678). Chi-square test showed that patients with single urinary infection and other indications have a higher chance of normal result on voiding cystourethrography (0.041 and 0.011 respectively). Logistic regressive analysis showed that patients whose referring specialist was urologist had 2.06 times higher chance for having pathologic finding on voiding cystourethrography (b=-0.810, p=0.007, odds ratio=0.445) compared to those referred by nephrologists. Conclusions: It is used as the “gold standard” radiographic test to diagnose vesicoureteral reflux. It is however associated by necessary radiation exposure. At our Institute pediatric urologists indicate voiding cystourethrography more cautiously compared to pediatric nephrologists. By avoiding voiding cystourethrography after single urinary tract infection and for other indications we could reduce the number of voiding cystourethrographies performed.