Voiding cystourethrography

And then

specifically, when you shouldn't or when you should consider getting a VCUG.

Let me dive a little bit deeper.

A lot of people use the renal bladder ultrasound or thought that a normal renal bladder ultrasound meant that that child who had a UTI doesn't have vesicular ureteral reflux and therefore not having VUR, I'll call it VUR, meant that that normal bladder ultrasound meant they didn't have VUR and they were done and there was nothing else to do.

So we don't want to miss those.

And it's something that we would be clinically actionable.

As it pertains to VCUG, while we say for most kids after their first febrile UTI, they don't need to have a VCUG, we do outline, because of the iterative process with urology and the nephrologists on the panel, We did highlight patients that have a very high likelihood of having vesicle ureteral reflux.

And so we do outline some special populations that if they have a febrile UTI and certain clinical characteristics of that UTI that should make you pause and think about, should I get a VCUG and not wait for the second one, even if the renal bladder ultrasound is normal? Yeah.

They're giving us age, uh, specific thresholds for antibiotic duration, um, and, um, route of antibiotics, and then giving some more, um, guidance on, uh, the imaging after.

The, the real change in guidance, uh, is that we can get a renal ultrasound and VCUG really not recommended unless there are abn- abnormalities on the renal ultrasound.

And they are giving us a much better definition of what should we consider, uh, as abnormal to proceed with VCUG.

Okay.

So that's the, the gist, okay, of things.

Yeah.

Key action statement number four.

In children younger than five years in whom a first febrile UTI has been diagnosed, there's a recommendation for renal and bladder ultrasonography rather than not performing renal bladder [laughs] ultrasonography, uh, and moving straight, uh, to VCUG.

They're giving us age, uh, specific thresholds for antibiotic duration, um, and, um, route of antibiotics, and then giving some more, um, guidance on, uh, the imaging after.

The, the real change in guidance, uh, is that we can get a renal ultrasound and VCUG really not recommended unless there are abn- abnormalities on the renal ultrasound.

And they are giving us a much better definition of what should we consider, uh, as abnormal to proceed with VCUG.

VCUG.Okay

So that's the, the gist, okay, of things.

Oh, and antibiotic prophylaxis.

Um, basically it says, you know, you get your imaging, you get your renal bladder ultrasound.

Are there abnormalities? Yes.

Recommending a renal bladder ultrasound after the first febrile UTI, referring kids to urology and or nephrology if they have abnormalities with the urinary tract.

And then they suggest routine VCUG after the second febrile UTI if that renal bladder ultrasound is unremarkable.

As far as other things, there are sort of two other things I was going to pull up.

The routine continuous antibiotic prophylaxis is not recommended for children with milder forms of vesicoureteral reflux, sorry, VUR, while awaiting urology referral.

And so I, you know, we've been talking a lot about diagnosis, which, and treatment, which is very useful for the generalist.

Um, but one of the big questions that have come up for us once we make our diagnoses and we think about sending these patients to urology is this whole RBUS VCUG imaging situation.

That's been a big question mark.

A lot of, lot of questions about the evidence in the past.

It's a little bit more nuanced, the 2011 guideline, but you'll find it's very similar to what you've been taught in the past.

The guideline says after the first UTI, you shouldn't consider getting an ultrasound.

If the ultrasound shows concerning abnormalities, and so we're not including things, and there is a list of what the abnormalities are, but like not including things like, um, you know, detritus in the bladder, which doesn't mean anything, but concerning abnormalities, then go ahead and get a VCUG.

If it doesn't show concerning abnormalities, stop.