Child Health  |  UTI Pathway - Micturating Cystourethrogram (MCUG)

Child Health

UTI Pathway - Micturating Cystourethrogram (MCUG)

A cystogram is performed to identify whether a child has the vesico-ureteric reflux. In the past, a large number of cystograms were done as it was thought that most upper urinary tract infections were due to reflux. However, it is now known that the majority of upper urinary tract infections are not due to reflux. Therefore, the number of children having a cystogram has dramatically reduced.

Modern indications for a cystogram include:

  • Recurrent urinary tract infections
  • Atypical urinary infections
  • An upper tract abnormality on urinary ultrasound

A cystogram involves inserting a fine catheter into the child's bladder, filling the bladder with radiographic contrast, and taking sequential x-ray images. This is usually done under a light general anaesthetic, to reduce the stress to child and parent. In infants less than 3 months of age a cystogram is done under local anaesthetic only. The procedure usually takes less than 5 minutes. After recovery, the child is free to go home. Often the procedure is covered with oral antibiotics.

DMSA scanning:

A DMSA scan is performed to assess differential kidney function, and is an excellent way to look for renal scarring, which can be associated with vesico-ureteric reflux. This investigation is performed in Hamilton.

Indications for DMSA scanning include:

  • High-grade reflux.
  • Suggestion of renal scarring on ultrasound scan (an ultrasound can be very inaccurate in assessing renal scarring).
  • Atypical or recurrent UTI in children less than 3 years of age.

Vesico-ureteric reflux:

Vesico-ureteric reflux is a complicated and controversial topic. A large proportion of reflux is not significant long-term and most children will grow out of and mild-to-moderate reflux, particularly if it is unilateral. In a small proportion of cases reflux requires surgical correction. This involves an open operation. The bladder is opened and a submucosal tunnel is developed, into which the dissected ureter is passed, and a new ureteric orifice is created. This tunnel prevents reflux by acting as a valve.

Indications for surgical correction of the vesico-ureteric reflux include:

  • Development of new renal scars.
  • Urinary infection while on antibiotic prophylaxis.
  • Persisting high-grade reflux.

Last updated : Thursday, May 18, 2017
Next review date : Friday, May 18,2018

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