The incidence of VUR was independent of degree of antenatal hydronephrosis, and a quarter of these were found to have no hydronephrosis on postnatal US [31]. There is disagreement over whether this VUR is clinically significant and therefore over the need for diagnosis. Some authors advocate VCUG for all infants with antenatal hydronephrosis, to guide treatment with prophylactic antibiotics [20,27,32,33]. However, currently, most authors (including the 2010 SFU consensus statement) recommend against routine VCUG for antenatal hydronephrosis [2,12,29,34,35]. This is largely because the benefit of prophylactic antibiotic in children with UTI has not been clearly demonstrated [36]. The efficacy of prophylactic antibiotics in preventing UTIs or renal damage in patients with antenatal hydronephrosis, with or without VUR, is difficult to determine because of variability in methods and results [39]. In addition, most of the VUR spontaneously resolves [40]. One of the potential risks of VCUG is iatrogenic UTI. This was reported in about 2% of VCUG studies performed for evaluation of antenatal hydronephrosis [39]. Voiding Urosonography Multiple recent investigations evaluating real-time contrast-enhanced US techniques have demonstrated a high degree of diagnostic accuracy, and some demonstrated increased sensitivity as compared to fluoroscopic VCUG in the detection of VUR [41-45]. The main potential disadvantage of voiding urosonography is a lower anatomical detail of the bladder and urethra, and therefore it should not be used as the first study for male patients. Therefore, arguments for and against using voiding urosonography are similar to that of VCUG with the exception of male patients. Nuclear Medicine Cystography Some studies have suggested equal sensitivity for Tc-99m pertechnetate radionuclide cystography and VCUG [46], whereas others have indicated that radionuclide cystography has improved sensitivity for VUR in infants up to 1 year of age [47].
Antenatal Hydronephrosis Infant. The incidence of VUR was independent of degree of antenatal hydronephrosis, and a quarter of these were found to have no hydronephrosis on postnatal US [31]. There is disagreement over whether this VUR is clinically significant and therefore over the need for diagnosis. Some authors advocate VCUG for all infants with antenatal hydronephrosis, to guide treatment with prophylactic antibiotics [20,27,32,33]. However, currently, most authors (including the 2010 SFU consensus statement) recommend against routine VCUG for antenatal hydronephrosis [2,12,29,34,35]. This is largely because the benefit of prophylactic antibiotic in children with UTI has not been clearly demonstrated [36]. The efficacy of prophylactic antibiotics in preventing UTIs or renal damage in patients with antenatal hydronephrosis, with or without VUR, is difficult to determine because of variability in methods and results [39]. In addition, most of the VUR spontaneously resolves [40]. One of the potential risks of VCUG is iatrogenic UTI. This was reported in about 2% of VCUG studies performed for evaluation of antenatal hydronephrosis [39]. Voiding Urosonography Multiple recent investigations evaluating real-time contrast-enhanced US techniques have demonstrated a high degree of diagnostic accuracy, and some demonstrated increased sensitivity as compared to fluoroscopic VCUG in the detection of VUR [41-45]. The main potential disadvantage of voiding urosonography is a lower anatomical detail of the bladder and urethra, and therefore it should not be used as the first study for male patients. Therefore, arguments for and against using voiding urosonography are similar to that of VCUG with the exception of male patients. Nuclear Medicine Cystography Some studies have suggested equal sensitivity for Tc-99m pertechnetate radionuclide cystography and VCUG [46], whereas others have indicated that radionuclide cystography has improved sensitivity for VUR in infants up to 1 year of age [47].