Vesicoureteral reflux: The Daily PANCE Blueprint

Home Vesicoureteral reflux: The Daily PANCE Blueprint

Vesicoureteral reflux: The Daily PANCE Blueprint

A 2-year-old female presents with crying while urinating. Her mother mentions that about 1 month ago she was treated for a UTI. In clinic today she is febrile. UA + leukocyte esterase and WBCs. Urine culture is ordered. The renal US shows hydronephrosis of the right kidney. After you give a course of antibiotics and the infection revolves, what is the next best step?

A. CT abdomen/pelvis
B. Voiding cystourethrography
C. Subureteric transurethral injection
D. DMSA renal scan
E. Repeat renal US

Answer and topic summary

The answer is B. Voiding cystourethrography

Vesicoureteral reflux is essentially defined as the backflow of urine from the bladder into the ureter. It is more common in children. There are 2 types: primary and secondary. Primary VUR is due to a short intramural ureter. Secondary VUR can be due to many things like 1) bladder outlet obstruction (from anatomical or functional issues); or 2) congenital anomaly (e.g., ectopic ureter). Clinical features include recurrent UTIs. Workup may include UA, urine culture, renal function test, ultrasound, and contrast voiding cystourethrogram (VCUG). In this question case, a VCUG is needed as this patient previously had a UTI and also had evidence of hydronephrosis. Treatment depends on the VUR grade and patient-by-patient case.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Genitourinary ⇒ Congenital and acquired abnormalities ⇒ Vesicoureteral reflux

Also covered as part of the Pediatric EOR topic list

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