Background Voiding cystourethrogram (VCUG) is considered the gold standard for detecting vesicoureteral reflux (VUR). Optimal timing of VCUG after urinary tract infections (UTI) is controversial. Single studies have compared rates of VUR according to timing of VCUG, but included a limited number of patients and failed to reach definitive conclusions.
Objective We conducted a systematic review and meta-analysis of studies that compared rates of VUR when VCUG was performed early versus late in the investigation of UTI.
Methods We searched MEDLINE, EMBASE, CINHAL and CENTRAL. We included studies that compared the rates of VUR between early versus late-performed VCUG in children diagnosed with UTI. We used the threshold of early vs. late reported by the authors: most commonly at 7 days, but no later than 14 days. Studies that focused on patients with previously diagnosed VUR or other urogenital pathology were excluded. Pairs of reviewers independently screened potentially eligible articles, extracted data and assessed quality of the evidence according to the GRADE framework.
Results Of the 1526 studies reviewed, 7 studies with 1623 patients were included (2 prospective and 5 retrospective cohort studies). Meta-analysis showed no increased risk of VUR in early versus late performed VCUG (Odds ratio 0.99, 95% CI 0.77 to 1.27, corresponding to a risk difference of 0.00, 95% CI -0.05 to 0.04, I2 = 0%). The overall quality of the evidence was moderate.
Conclusions In children diagnosed with UTI, there is no significant difference in rates of VUR when VCUG is performed early rather than later.