Open Access

PEDIATRIC UROLOGY

Multicystic dysplastic kidney: is an initial voiding cystourethrogram necessary?

Adam C. Calaway¹, Benjamin Whittam¹, Konrad M. Szymanski¹, Rosalia Misseri¹, Martin Kaefer¹, Richard C. Rink¹, Boaz Karymazn², Mark P. Cain¹

1 Division of Pediatric Urology, Riley Hospital for Children at Indiana University School of Medicine, Indianapolis, Indiana, USA
2 Division of Pediatric Radiology, Riley Hospital For Children at Indiana University School of Medicine, Indianapolis, Indiana, USA
Address correspondence to Dr. Adam C. Calaway, Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN 46202 USA

Canadian Journal of Urology 2014, 21(5), 7510-7514.

Abstract

Introduction: Traditionally, a voiding cystourethrogram (VCUG) has been obtained in patients diagnosed with multicystic dysplastic kidney (MCDK) because of published vesicoureteral reflux (VUR) rates between 10%–20%. However, with the diagnosis and treatment of low grade VUR undergoing significant changes, we questioned the utility of obtaining a VCUG in healthy patients with a MCDK. We reviewed our experience to see how many of the patients with documented VUR required surgical intervention.
Materials and methods: We performed a retrospective review of children diagnosed with unilateral MCDK from 2002 to 2012 who also underwent a VCUG.
Results: A total of 133 patients met our inclusion criteria. VUR was identified in 23 (17.3%) children. Four patients underwent ureteral reimplant (3.0%). Indications for surgical therapy included breakthrough urinary tract infections (2 patients), evidence of dysplasia/scarring (1 patient) and non-resolving reflux (1 patient). All patients with a history of VUR who are toilet trained, regardless of the grade or treatment, are currently being followed off antibiotic prophylaxis. To date, none have had a febrile urinary tract infection (UTI) since cessation of prophylactic antibiotics. Hydronephrosis in the contralateral kidney was not predictive of VUR (p = 0.99).
Conclusion: Routine VCUG in healthy children diagnosed with unilateral MCDK may not be warranted given the low incidence of clinically significant VUR. If a more conservative strategy is preferred, routine VCUG may be withheld in those children without normal kidney hydronephrosis and considered in patients with normal kidney hydronephrosis. If a VCUG is not performed the family should be instructed in signs and symptoms of urinary tract infection.

---

Keywords

---