Multi-institutional experience with PIC cystography - Incidence of occult vesicoureteral reflux in children with febrile urinary tract infections

John D. Edmondson*, Max Maizels, Seth A. Alpert, Andrew J. Kirsch, Moneer K. Hanna, Adam C. Weiser, Paolo Caione, William E. Kaplan, Earl Y. Cheng, John T B Houston

*Corresponding author for this work

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objectives. It has been reported that all children with febrile urinary tract infections (FUTIs) and normal voiding cystourethrogram (VCUG) findings show occult reflux (vesicoureteral reflux [VUR]) when examined by cystography performed with positioning of the instillation of contrast at the ureteral orifice (PIC cystography). In this study, we evaluated the reproducibility of this finding using a prospective multi-institutional collaborative examination to determine whether PIC-VUR is as common in such cases as previously shown. Methods. From March 2002 to October 2003, four institutions performed PIC cystography consecutively and prospectively in pediatric cases of FUTI (greater than 101°F) who had not shown VUR by conventional VCUG. We correlated the ureteral orifice (UO) configuration and position with the status of PIC-VUR. Results. PIC cystography was performed in 39 children (31 girls and 8 boys; 75 FUTIs). We identified PIC-VUR in 32 (82%) of 39 children, involving 58 (74%) of 78 ureters. The likelihood of demonstrating PIC-VUR was increased 37-fold if the UO showed a patulous configuration and was increased 9-fold if the UO showed a lateral configuration. PIC-VUR was noted uniformly in UOs showing hydrodistension. Conclusions. This multi-institutional registry showed that the incidence of PIC-VUR (82%) in children with FUTI and normal standard VCUG findings is similar to that previously reported. We consider that PIC-VUR likely accounts for the FUTIs.

Original languageEnglish (US)
Pages (from-to)608-611
Number of pages4
JournalUrology
Volume67
Issue number3
DOIs
StatePublished - Mar 1 2006

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Vesico-Ureteral Reflux
Urinary Tract Infections
Fever
Incidence
Cystography
Ureter
Reproducibility of Results
Registries
Pediatrics

ASJC Scopus subject areas

  • Urology

Cite this

Edmondson, John D. ; Maizels, Max ; Alpert, Seth A. ; Kirsch, Andrew J. ; Hanna, Moneer K. ; Weiser, Adam C. ; Caione, Paolo ; Kaplan, William E. ; Cheng, Earl Y. ; Houston, John T B. / Multi-institutional experience with PIC cystography - Incidence of occult vesicoureteral reflux in children with febrile urinary tract infections. In: Urology. 2006 ; Vol. 67, No. 3. pp. 608-611.
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title = "Multi-institutional experience with PIC cystography - Incidence of occult vesicoureteral reflux in children with febrile urinary tract infections",
abstract = "Objectives. It has been reported that all children with febrile urinary tract infections (FUTIs) and normal voiding cystourethrogram (VCUG) findings show occult reflux (vesicoureteral reflux [VUR]) when examined by cystography performed with positioning of the instillation of contrast at the ureteral orifice (PIC cystography). In this study, we evaluated the reproducibility of this finding using a prospective multi-institutional collaborative examination to determine whether PIC-VUR is as common in such cases as previously shown. Methods. From March 2002 to October 2003, four institutions performed PIC cystography consecutively and prospectively in pediatric cases of FUTI (greater than 101°F) who had not shown VUR by conventional VCUG. We correlated the ureteral orifice (UO) configuration and position with the status of PIC-VUR. Results. PIC cystography was performed in 39 children (31 girls and 8 boys; 75 FUTIs). We identified PIC-VUR in 32 (82{\%}) of 39 children, involving 58 (74{\%}) of 78 ureters. The likelihood of demonstrating PIC-VUR was increased 37-fold if the UO showed a patulous configuration and was increased 9-fold if the UO showed a lateral configuration. PIC-VUR was noted uniformly in UOs showing hydrodistension. Conclusions. This multi-institutional registry showed that the incidence of PIC-VUR (82{\%}) in children with FUTI and normal standard VCUG findings is similar to that previously reported. We consider that PIC-VUR likely accounts for the FUTIs.",
author = "Edmondson, {John D.} and Max Maizels and Alpert, {Seth A.} and Kirsch, {Andrew J.} and Hanna, {Moneer K.} and Weiser, {Adam C.} and Paolo Caione and Kaplan, {William E.} and Cheng, {Earl Y.} and Houston, {John T B}",
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Multi-institutional experience with PIC cystography - Incidence of occult vesicoureteral reflux in children with febrile urinary tract infections. / Edmondson, John D.; Maizels, Max; Alpert, Seth A.; Kirsch, Andrew J.; Hanna, Moneer K.; Weiser, Adam C.; Caione, Paolo; Kaplan, William E.; Cheng, Earl Y.; Houston, John T B.

In: Urology, Vol. 67, No. 3, 01.03.2006, p. 608-611.

Research output: Contribution to journalArticle

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T1 - Multi-institutional experience with PIC cystography - Incidence of occult vesicoureteral reflux in children with febrile urinary tract infections

AU - Edmondson, John D.

AU - Maizels, Max

AU - Alpert, Seth A.

AU - Kirsch, Andrew J.

AU - Hanna, Moneer K.

AU - Weiser, Adam C.

AU - Caione, Paolo

AU - Kaplan, William E.

AU - Cheng, Earl Y.

AU - Houston, John T B

PY - 2006/3/1

Y1 - 2006/3/1

N2 - Objectives. It has been reported that all children with febrile urinary tract infections (FUTIs) and normal voiding cystourethrogram (VCUG) findings show occult reflux (vesicoureteral reflux [VUR]) when examined by cystography performed with positioning of the instillation of contrast at the ureteral orifice (PIC cystography). In this study, we evaluated the reproducibility of this finding using a prospective multi-institutional collaborative examination to determine whether PIC-VUR is as common in such cases as previously shown. Methods. From March 2002 to October 2003, four institutions performed PIC cystography consecutively and prospectively in pediatric cases of FUTI (greater than 101°F) who had not shown VUR by conventional VCUG. We correlated the ureteral orifice (UO) configuration and position with the status of PIC-VUR. Results. PIC cystography was performed in 39 children (31 girls and 8 boys; 75 FUTIs). We identified PIC-VUR in 32 (82%) of 39 children, involving 58 (74%) of 78 ureters. The likelihood of demonstrating PIC-VUR was increased 37-fold if the UO showed a patulous configuration and was increased 9-fold if the UO showed a lateral configuration. PIC-VUR was noted uniformly in UOs showing hydrodistension. Conclusions. This multi-institutional registry showed that the incidence of PIC-VUR (82%) in children with FUTI and normal standard VCUG findings is similar to that previously reported. We consider that PIC-VUR likely accounts for the FUTIs.

AB - Objectives. It has been reported that all children with febrile urinary tract infections (FUTIs) and normal voiding cystourethrogram (VCUG) findings show occult reflux (vesicoureteral reflux [VUR]) when examined by cystography performed with positioning of the instillation of contrast at the ureteral orifice (PIC cystography). In this study, we evaluated the reproducibility of this finding using a prospective multi-institutional collaborative examination to determine whether PIC-VUR is as common in such cases as previously shown. Methods. From March 2002 to October 2003, four institutions performed PIC cystography consecutively and prospectively in pediatric cases of FUTI (greater than 101°F) who had not shown VUR by conventional VCUG. We correlated the ureteral orifice (UO) configuration and position with the status of PIC-VUR. Results. PIC cystography was performed in 39 children (31 girls and 8 boys; 75 FUTIs). We identified PIC-VUR in 32 (82%) of 39 children, involving 58 (74%) of 78 ureters. The likelihood of demonstrating PIC-VUR was increased 37-fold if the UO showed a patulous configuration and was increased 9-fold if the UO showed a lateral configuration. PIC-VUR was noted uniformly in UOs showing hydrodistension. Conclusions. This multi-institutional registry showed that the incidence of PIC-VUR (82%) in children with FUTI and normal standard VCUG findings is similar to that previously reported. We consider that PIC-VUR likely accounts for the FUTIs.

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