Purpose: Voiding cystourethrogram (VCUG) is an invasive and uncomfortable test. The indications for obtaining a VCUG in the pediatric population have been loosely defined. This study looks at the likelihood of having a positive VCUG based on patient symptoms.
Methods: The charts of 219 children presenting with an initial urinary tract infection requiring VCUG were retrospectively reviewed. Data collected included the indication for VCUG, clinical evidence for urinary infection, symptoms of dysfunctional elimination (DES), sex and age. Patients who had no history of urinary tract infection (UTI) were excluded from analysis, as were those individuals under 2 years of age, since the diagnosis of DES is not possible. Data was analyzed using Fisher’s Exact Test, two tailed with a 95% confidence interval.
Results: For patients >= 2 years of age, 35 of 73 (48%) children with febrile UTI had VUR, while 17 of 52 (33%) with nonfebrile infection had reflux (p=.06). Dilating reflux was seen in 25% and 10% of these groups, respectively (p=.02). In children with no symptoms of DES, 35 of 65 (54%) had reflux, as compared to 17 of 60 (28%) children with DES (p=0.003). In those two groups, 28% of children without DES and 8% of children with DES had dilating reflux (p=0.004). In children with febrile infection and no DES symptoms, 27 of 43 (63%) had reflux, while 9 of 30 (30%) children with nonfebrile infection and DES had reflux (p=0.005). These groups had a 28% and 6% incidence of dilating VUR respectively (p=0.002), and a 33% and 3% incidence of bilateral reflux respectively (p=.001).
Conclusion: The findings suggest that in children over the age of 2 years, those individuals with symptoms of DES and nonfebrile infection are unlikely to have reflux, and thus may not require VCUG unless there are other indications, such as abnormal ultrasound findings. Among children with a history of UTI, DES is a significant negative predictor of vesicoureteral reflux.

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