Korean J Urogenit Tract Infect Inflamm.  2013 Apr;8(1):38-42. 10.14777/kjutii.2013.8.1.38.

Comparative Analysis between Top-Down and Down-Top Approach in Children with Febrile Urinary Tract Infection

  • 1Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea. lsd@pusan.ac.kr


We performed a comparative analysis of the usefulness of top-down and down-top approach in children with febrile urinary tract infection (UTI).
Among 79 children, 42 children had undergone voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) scintigraphy. High grade vesicoureteral reflux (VUR) was defined as grade VI and V. We analyzed the detection rate of VUR between down-top (group I) and top-down approach (group II).
The mean age of 42 children (Boys 25, girls 17) was 30.3+/-33.2 years. Among 42 children, 22 (52.4%) were diagnosed as VUR. Detection rate of VUR in groups I and II was 52.4% and 33.3%, respectively (p=0.078). Detection rate of VUR according to sex and age was 56.0% and 36.0% in boys (p=0.156), 47.1% and 29.4% in girls (p=0.290), and 38.9% and 16.7% in children younger than one year of age (p=0.041), and 62.5% and 45.8% in children older than one year of age (p=0.247), respectively. In high grade VUR, there was a similar detection rate of VUR, regardless of sex or age. Sensitivity, specificity, and positive prediction rate of DMSA scintigraphy in all patients and children with high grade VUR were 63.6%, 80.0%, 77.8%, and 84.6%, 80.0%, 73.3%, respectively.
In children with febrile UTI who were younger one year of age, down-top approach was more useful for diagnosis of VUR. Therefore, VCUG may initially be needed for diagnosis of VUR in children with febrile UTI who were younger than one year of age.


Vesicoureteral reflux; Child; Urinary tract infections
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