Voiding Cystourethrogram (VCUG)

After the patient's bladder is filled with a liquid called contrast material, an X-ray machine sends beams of radiation through the abdomen and pelvis, and images are recorded on special film or a computer. These images help doctors see problems in parts of the urinary system, including the bladder, urethra (the tube connecting the bladder with the outside of the body), and the ureters (the tubes connecting the kidneys to the bladder).

A radiologist takes the X-rays using a technique called fluoroscopy. While the contrast material fills your child's bladder, and then while your child empties the bladder, the radiologist watches an onscreen X-ray video of the liquid moving through the urinary system and a series of X-ray films is recorded.

In general, X-rays are very safe. Although there is some risk to the body with any exposure to radiation, the amount used in a VCUG is small and not considered dangerous. It's important to know that Nemours radiologists use the minimum amount of radiation required to perform the study properly.

 
What does a VCUG show?

A VCUG can show whether the urine is moving in the right direction. Normally, urine flows from the kidneys down to the bladder through the ureters. When urine goes back up toward the kidneys, it's called vesicoureteral reflux (VUR), which a VCUG can detect. Sometimes VUR only occurs while urinating (voiding), which is why the VCUG includes taking X-ray images while the bladder is being emptied.

 
About Sedation

At times, fear, anxiety, and developmental stage of a child contribute to his or her ability to cooperate with medical procedures. Pediatric procedural sedation can be used to decrease discomfort and anxiety for your child.

Sedation is available for VCUG and a separate sedation appointment would be needed to be scheduled prior to the study.

Providing sedation means a child is given medicine to make the child more relaxed. When a child is sedated, he or she may better tolerate a medical procedure and will probably not remember it.

The sedation team aims for mild to moderate sedation, meaning that your child will be relaxed, but awake enough to answer questions and to sense a full bladder. Typical sedatives for this procedure include midazolam (Versed), given orally or as a nasal spray, or nitrous oxide (“laughing gas”) given with a mask. This procedure takes about 10 minutes for catheter placement and bladder filling, and another few minutes for the child to urinate.

Urinary Tract Infections

Urinary tract infections (UTIs) are common in kids. They happen when bacteria (germs) get into the bladder or kidneys.

A baby with a UTI may have a fever, throw up, or be fussy. Older kids may have a fever, have pain when peeing, need to pee a lot, or have lower belly pain.

Kids with UTIs need to see a doctor. These infections won't get better on their own. UTIs are easy to treat and usually clear up in a week or so.

Taking antibiotics kills the germs and helps kids get well again. To be sure antibiotics work, you must give all the prescribed doses — even when your child starts feeling better.

What Are the Signs of a UTI?

Most UTIs happen in the lower part of the urinary tract — the urethra and bladder. This type of UTI is called cystitis. A child with cystitis may have:

  • pain, burning, or a stinging sensation when peeing
  • an increased urge or more frequent need to pee (though only a very small amount of pee may be passed)
  • fever
  • waking up at night a lot to go to the bathroom
  • wetting problems, even though the child is potty trained
  • belly pain in the area of the bladder (generally below the belly button)
  • foul-smelling pee that may look cloudy or contain blood

An infection that travels up the ureters to the kidneys is called pyelonephritis and is usually more serious. It causes many of these same symptoms, but the child often looks sicker and is more likely to have a fever (sometimes with shaking chills), pain in the side or back, severe tiredness, or vomiting.

Who Gets UTIs?

UTIs are much more common in girls because a girl's urethra is shorter and closer to the anus. Uncircumcised boys younger than 1 year also have a slightly higher risk for a UTI.

Other risk factors for a UTI include:

  • a problam in the urinary tract (for example, a malformed kidney or a blockage somewhere along the tract of normal urine flow)
  • an abnormal backward flow (reflux) of urine from the bladder up the ureters and toward the kidneys. This is known as vesicoureteral reflux (VUR), and many kids with a UTI are found to have it.
  • poor toilet and hygiene habits
  • family history of UTIs

UTIs are easy to treat, but it's important to catch them early. Undiagnosed or untreated UTIs can lead to kidney damage.

How Are UTIs Diagnosed?

To diagnose a UTI, health care providers ask questions about what's going on, do a physical exam, and take a sample of pee for testing.

How a sample is taken depends on a child's age. Older kids might simply need to pee into a sterile cup. For younger children in diapers, a catheter is usually preferred. This is when a thin tube is inserted into the urethra up to the bladder to get a "clean" urine sample.

The sample may be used for a urinalysis (a test that microscopically checks the urine for germs or pus) or a urine culture (which attempts to grow and identify bacteria in a laboratory). Knowing what bacteria are causing the infection can help your doctor choose the best treatment.

How Are UTIs Treated?

UTIs are treated with antibiotics. After several days of antibiotics, your doctor may repeat the urine tests to confirm that the infection is gone. It's important to make sure of this because an incompletely treated UTI can come back or spread.

If a child has severe pain when peeing, the doctor may also prescribe medicine that numbs the lining of the urinary tract. (This medication temporarily causes the pee to turn orange.)

Give prescribed antibiotics on schedule for as many days as your doctor directs. Keep track of your child's trips to the bathroom, and ask your child about symptoms like pain or burning during peeing. These symptoms should improve within 2 to 3 days after antibiotics are started.

Encourage your child to drink plenty of fluids, but avoid beverages containing caffeine, such as soda and iced tea.

Treatment for More Severe UTIs

Kids with a more severe infection may need treatment in a hospital so they can get antibiotics by injection or intravenously (delivered through a vein right into the bloodstream).

This might happen if:

  • the child has high fever or looks very ill, or a kidney infection is likely
  • the child is younger than 6 months old
  • bacteria from the infected urinary tract may have spread to the blood
  • the child is dehydrated (has low levels of body fluids) or is vomiting and cannot take any fluids or medicine by mouth

Kids with VUR will be watched closely by the doctor. VUR might be treated with medicines or, less commonly, surgery. Most kids outgrow mild forms of VUR, but some can develop kidney damage or kidney failure later in life.

Can UTIs Be Prevented?

In infants and toddlers, frequent diaper changes can help prevent the spread of bacteria that cause UTIs. When kids are potty trained, it's important to teach them good hygiene. Girls should know to wipe from front to rear — not rear to front — to prevent germs from spreading from the rectum to the urethra.

School-age girls should avoid bubble baths and strong soaps that might cause irritation, and they should wear cotton underwear instead of nylon because it's less likely to encourage bacterial growth.

All kids should be taught not to "hold it" when they have to go because pee that stays in the bladder gives bacteria a good place to grow. Kids should drink plenty of fluids and avoid caffeine, which can irritate the bladder.

Most UTIs are cured within a week with treatment.

When to Call the Doctor

Call your doctor immediately if your child has an unexplained fever with shaking chills, especially if there's also back pain or any type of pain when peeing.

Also call if your child has any of the following:

  • bad-smelling, bloody, or discolored pee
  • low back pain or belly pain (especially below the belly button)
  • a fever of over 101°F (38.3°C) in children or 100.4°F (38°C) rectally in infants

Call the doctor if your infant has a fever, feeds poorly, vomits repeatedly, or seems unusually irritable.

Reviewed by: T. Ernesto Figueroa, MD
Date reviewed: March 31, 2017