There is conflicting evidence on the sensitivity of renal cortical scintigraphy and the top-down approach in the detection of sequela of VUR [45,56,57]. In a randomized controlled study comparing oral versus IV antibiotic administration, 308 patients who had Tc-99m DMSA were evaluated. The sensitivity of this top-down approach for VUR detection was 70%, with specificity of 42% [45]. A meta-analysis on the use of DMSA in acute UTI yielded a sensitivity and specificity of 79% and 53%, respectively, for grades 3 to 5 VUR. There was marked statistical heterogeneity between the studies. The authors concluded that acute-phase DMSA renal scanning is not useful as a replacement for VCUG in the evaluation of young children with a first febrile UTI [56]. Fluoroscopy Voiding Cystourethrography The Randomized Intervention for Children With Vesicoureteral Reflux study, which enrolled 607 children, 2 months to 6 years of age with any grade of VUR, demonstrated that 2 years of prophylactic antibiotics in children with VUR decreased the incidence of recurrent UTIs by half (number needed to treat for 2 years was 8) [58]. Patients with high-grade VUR (grades III and IV) are more likely to have recurrent UTIs and scarring [7,43,50,58-61] and may benefit even more from prophylactic antibiotics. The Swedish study randomly assigned 203 children, 12 to 23 months of age, with dilated (grade III or IV) VUR and demonstrated benefit only in patients AFAB who received either prophylactic antibiotics or endoscopic treatment in decreasing recurrent UTI (number needed to treat for 2 years, 2.5 and 3, respectively) [62]. Patients AFAB who received antimicrobial prophylaxis had the lowest incidence of renal scarring (number needed to treat for 2 years was 5) [62]. The NICE guidelines do not recommend VCUG for patients from 6 months to 3 years of age with first febrile UTI who respond well to treatment within 48 hours and have a normal renal and bladder US study, normal urine flow, and no family history of VUR.
Urinary Tract Infection Child. There is conflicting evidence on the sensitivity of renal cortical scintigraphy and the top-down approach in the detection of sequela of VUR [45,56,57]. In a randomized controlled study comparing oral versus IV antibiotic administration, 308 patients who had Tc-99m DMSA were evaluated. The sensitivity of this top-down approach for VUR detection was 70%, with specificity of 42% [45]. A meta-analysis on the use of DMSA in acute UTI yielded a sensitivity and specificity of 79% and 53%, respectively, for grades 3 to 5 VUR. There was marked statistical heterogeneity between the studies. The authors concluded that acute-phase DMSA renal scanning is not useful as a replacement for VCUG in the evaluation of young children with a first febrile UTI [56]. Fluoroscopy Voiding Cystourethrography The Randomized Intervention for Children With Vesicoureteral Reflux study, which enrolled 607 children, 2 months to 6 years of age with any grade of VUR, demonstrated that 2 years of prophylactic antibiotics in children with VUR decreased the incidence of recurrent UTIs by half (number needed to treat for 2 years was 8) [58]. Patients with high-grade VUR (grades III and IV) are more likely to have recurrent UTIs and scarring [7,43,50,58-61] and may benefit even more from prophylactic antibiotics. The Swedish study randomly assigned 203 children, 12 to 23 months of age, with dilated (grade III or IV) VUR and demonstrated benefit only in patients AFAB who received either prophylactic antibiotics or endoscopic treatment in decreasing recurrent UTI (number needed to treat for 2 years, 2.5 and 3, respectively) [62]. Patients AFAB who received antimicrobial prophylaxis had the lowest incidence of renal scarring (number needed to treat for 2 years was 5) [62]. The NICE guidelines do not recommend VCUG for patients from 6 months to 3 years of age with first febrile UTI who respond well to treatment within 48 hours and have a normal renal and bladder US study, normal urine flow, and no family history of VUR.