Urinary imaging is essential because UTI in children is usually the first presenting sign of urinary tract anomaly.
Early diagnosis and treatment of major urinary tract anomaly are important to prevent renal damage. But there is still considerable disagreement as to what investigation should be undertaken first. Until several years ago, IVP and VCUG were included as routine tests in all children after the first or second UTI. Recent studies indicate the ultrasound can effectively replace IVP as a screening procedure and Tc-DMSA scan is more sensitive than IVP for the detection of early stage of renal scar and predictability of VUR.
We performed the various imaging studies of urinary tract in 142 children, diagnosed as the first UTI in Pediatric department of E.W.U.H. from March, 1984 to March, 1990 .and evaluated the results retrospectively.
The results were as follows :
1) Abnormalities were observed in 42 of 142 children with UTI(29.6% ), 30 of 101 male(29. 7%) and 12 of 41 female(29.2 %) .
2) Urinary tract anomalies were 22 primary vesicoureteral refluxes(15.5 % ), 9 obstructive uropathy(6.3% ), 3 non-obstructing, non-refluxing megaureter(2.1 % ), 3 stones(2.1 % ), 3 renal anomaly(2.1 % ), one bladder diverticulum(0.7%). Obstructive uropathy was detected more in male than female(p<0.05). Renal scars were observed in 10, 7 in male(6.9% ) and 3 in female(7.3%)
3) The detection rates of _abnormal finding were not significantly different, 16.9% in VCUG, 22.2% in IVP, 23.3% in US and 28.1% in Tc-DMSA scan.
4) VUR, bladder diverticulum and PUV were 100% diagnosed by VCUG. Renal anomaly and dilated `urinary tract of obstructive uropathy and non-obst. non-reflux. megaureter were 100% detected by US, IVP anddTc-DMSA scan. One of 3 stones was missed by US but detected during VCUG. Ectopic ureter was the only one that needed IVP.
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