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International braz j urol

Print version ISSN 1677-5538

Int. braz j urol. vol.36 no.5 Rio de Janeiro Sept./Oct. 2010

http://dx.doi.org/10.1590/S1677-55382010000500028 

UROLOGICAL SURVEY

 

Pediatric Urology

 

Value of ultrasound in evaluation of infants with first urinary tract infection

 

Preda I, Jodal U, Sixt R, Stokland E, Hansson S
Department of Pediatrics, Queen Silvia Children’s Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
J Urol. 2010; 183: 1984-8

Purpose: We evaluated the role of ultrasound in diagnosing and treating infants with a first urinary tract infection with a focus on important structural abnormalities.
Materials and Methods: In a setting of limited prenatal ultrasound screening this population based, prospective, 3-year study included 161 male and 129 female infants. Ultrasound and dimercapto-succinic acid scintigraphy were performed as initial investigations and voiding cystourethrography was conducted within 2 months.
Results: Ultrasound revealed dilatation in 15% of patients and increased kidney length in 28%. Sensitivity for detecting scintigraphic abnormality was 48%. Renal length was significantly correlated to inflammatory parameters, including scintigraphic abnormalities. Important structural abnormalities were detected in 40 cases, with 30 on ultrasound, while 10 of 27 cases of dilating reflux (mostly grade III) were missed. Outside the study there were 28 additional cases of structural abnormality, of which 15 were detected prenatally.
Conclusions: Ultrasound detected most structural abnormalities except grade III reflux. Since it is noninvasive, ultrasound has a place in the evaluation of infants with urinary tract infection, especially in the absence of prenatal ultrasound during late pregnancy. Kidney length in infants with acute infection correlated with inflammatory parameters, and the clinical importance of this finding needs to be studied further.

Editorial Comment

This is a population-based, prospective study looking at all patients younger than one year of age who presented with a urinary tract infection to a single institution over 3 years. They were able to get complete data on 290 patients, all of whom underwent DMSA scan and ultrasonography acutely and then a VCUG within two months of diagnosis. Structural abnormalities were detected in 40 patients. Ultrasound was able to detect abnormalities in all but 10 of these patients. These 10 patients had "dilating" vesicoureteral reflux. 12 of the 40 patients went on to require surgery, but only 6 of those procedures were for reflux. Other important abnormalities detected included UPJ obstruction, UVJ obstruction and ureterocele.

As we continue to evaluate the pros and cons of a top down versus bottom up approach to reflux, this study highlights the continued value of ultrasonography for pediatric patients. Some have questioned the usefulness of ultrasonography for evaluation of children with a urinary tract infection. The fact that ultrasonography is readily available, non-invasive, and does not require radiation exposure will likely ensure that this imaging modality will not be left to the wayside regardless of which approach one chooses.

 

M. Chad Wallis
Division of Pediatric Urology
University of Utah
Salt Lake City, Utah, USA
E-mail: chad.wallis@hsc.utah.edu

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