TY  - EJOU
AU  - Calaway, Adam C. 
AU  - Whittam, Benjamin 
AU  - Szymanski, Konrad M. 
AU  - Misseri, Rosalia 
AU  - Kaefer, Martin 
AU  - Rink, Richard C. 
AU  - Karymazn, Boaz 
AU  - Cain, Mark P. 

TI  - Multicystic dysplastic kidney: is an initial voiding cystourethrogram necessary?
T2  - Canadian Journal of Urology

PY  - 2014
VL  - 21
IS  - 5
SN  - 1488-5581

AB  - <b>Introduction:</b> 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.<br/>
<b>Materials and methods:</b> We performed a retrospective review of children diagnosed with unilateral MCDK from 2002 to 2012 who also underwent a VCUG.<br/>
<b>Results:</b> 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).<br/>
<b>Conclusion:</b> 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.
KW  - multicystic dysplastic kidney
KW  -  voiding cystourethrogram
KW  -  vesicoureteral reflux

DO  -