Positional installation of contrast (PIC) and Redo-PIC cystography for diagnosis of occult vesicoureteral reflux

Abstract

To evaluate the value of Positional Installation of Contrast (PIC) and RedoPIC cystography in patients with febrile recurrent urinary tract infection(f-UTI) where voiding cystourethrogram (VCUG) was negative. Patients withrecurrent f-UTI with no reflux on VCUG referred to the outpatient clinicof Pediatric Urology, between June 2011 and June 2016 were included inthe study. A PIC cystography was performed in all patients. When refluxwas found, subureteric injection was performed. Urinary cultures wereused for follow-up. Patients that continued having f-UTI, received redo-PICcystography. PIC cystography was performed on 42 patients. The average ageof patients was 8.0±3.6 years. Vesicoureteral reflux (VUR) was detected in41 patients. Average follow-up time after PIC cystography was 44.6 months.Thirty-three patients (80.5%) were free of f-UTI after PIC cystography andconcurrent subureteric injection. Eight patients continued to have recurrentf-UTI. Six of these patients underwent redo-PIC cystography and PIC-VURwas demonstrated in all patients. After an average follow up of 30.9 months,no f-UTI was seen in these patients. The success rate of 80.5% (33/41) after1st PIC cystography and subureteric injection increased to 95.1% (39/41)after redo-PIC cystography in six patients. Patients with recurrent f-UTIswithout VUR on VCUG are an important challenge. PIC cystography is animportant tool in demonstrating occult VUR in these patients. We advisethat PIC cystography is performed in all patients with recurrent f-UTI withnegative VCUG and redo-PIC cystography in patients who continue to havef-UTI after 1st PIC cystography and subureteric injection.