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Is a Voiding Cystourethrogram Necessary in the Workup of Patients with a Multicystic Dysplastic Kidney
Adam Calaway, MD, Benjamin Whittam, MD, Konrad Szymanski, MD, Rosalia Misseria, MD, Martin Kaefer, MD, Boaz Karmazyn, MD, Richard Rink, MD, Mark Cain, MD.
Riley Hospital for Children at IU Health, Indianapolis, IN, USA.

Is a Voiding Cystourethrogram Necessary in the Workup of Patients with a Multicystic Dysplastic Kidney?
Introduction: At our institution, a voiding cystourethrogram (VCUG) is obtained in all patients diagnosed with a multicystic dysplastic kidney (MCDK), because of published vesicoureteral reflux (VUR) rates between 20-40%. 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 therapy.
Materials and Methods: We performed a 10-year retrospective review of children diagnosed with unilateral MCDK who underwent a VCUG. We excluded patients with significant medical comorbidities, ureteroceles, or complex urogenital anomalies (e.g., cloacal anomalies, bladder exstrophy). We investigated the prevalence of VUR in this patient population and attempted to delineate any potential risk factors or morbidity associated with VUR.
Results: 133 patients met our inclusion criteria. VUR was identified in 22 (16.5%) children.
VURLow Grade (I-II)Moderate Grade (III)Severe Grade (IV-V)
MCDK612
Normal Kidney773

Three patients underwent ureteral reimplant (2.3%), two for nonresolving VUR and one for breakthrough febrile urinary tract infections. The remaining patients either resolved their reflux or are currently being followed off antibiotic prophylaxis. The patients that underwent surgery for nonresolving reflux would likely be followed clinically using current guidelines. Hydronephrosis in the contralateral kidney was not predictive of VUR (p = 1.0).
Conclusion: Routine VCUG in healthy children diagnosed with unilateral MCDK may not be warranted given the low incidence of clinically significant VUR. We recommend following SFU guidelines regarding workup of hydronephrosis in the normal kidney. If a VCUG is not performed the family should be instructed in signs and symptoms of a urinary tract infection.


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