Multicystic dysplastic kidney: Is an initial voiding cystourethrogram necessary?

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

Research output: Contribution to journalArticle

18 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)7510-7514
Number of pages5
JournalCanadian Journal of Urology
Volume21
Issue number5
StatePublished - Jan 1 2014

Keywords

  • Multicystic dysplastic kidney
  • Vesicoureteral reflux
  • Voiding cystourethrogram

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

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