HWN Suggests

“Medically Sanctioned Rape”: In Defense of VCUG Survivors

The voiding cystourethrogram (VCUG) test is the “gold standard” for diagnosing vesicoureteral reflux (VUR) in pediatric urology. Since its initiation in the 1960s, the test has persisted unchanged. More notably, this test 1.) is being performed without the enforcement of a standardized protocol and 2.) in violation of the informed consent doctrine... The American Academy of Pediatrics (AAP) and the American Urological Association (AUA) have failed to implement a standardized protocol for VCUG for several decades. This is alarming given that research shows “VCUG protocols vary substantially” among medical institutions:

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Featured

  Does Your Child Have Frequent UTIs? A Safer Way to Screen for VUR

Contrast-enhanced voiding urosonography (or ceVUS) is a new procedure that uses ultrasound with contrast to image a child’s urinary tract. During ceVUS, a child will have a catheter with a special ultrasound contrast solution inserted through their urethra, much like a VCUG. But instead of x-rays, this exam uses ultrasound to image the bladder and urethra.

  Unsilenced Movement

The Unsilenced Movement is on a mission to put parents and patients back in the driver's seat by empowering and educating families about VCUG... We know how terrifying it is to come to terms with VCUG trauma. It takes tremendous courage to scour the internet for answers to explain our lifelong struggles, but you're not alone. The Unsilenced Movement exists because we know how it feels to be in your shoes. We understand the frustration of Googling "VCUG trauma" just to read words like painless, safe, and low-risk. Many former patients repress VCUG trauma for many years due to dissociative amnesia, delaying the recall of essential knowledge we need to recover from traumatic experiences in early childhood. Our organization is dedicated to ensuring these answers are accessible and available to survivors and their loved ones, empowering them to take the first step toward healing.

 As kids, they underwent a common test for UTIs. As adults, it haunts them as a traumatic ‘nightmare’

It’s been nearly three decades since Shelby Smith underwent a series of invasive procedures as a young child to diagnose the cause of recurring urinary tract infections. But the trauma of the procedure, which required her to be restrained while a physician threaded a catheter up her urinary tract without sedation, still impacts her profoundly.

 More Than a Test

In this short documentary film, Unsilenced Movement founder Shelby Smith reveals the dark underbelly of voiding cystourethrograms (VCUGs), the "gold standard" test to diagnose vesicoureteral reflux (VUR) in pediatric patients. The VCUG test is performed on up to 1 million children every year while being falsely promoted as safe, low-risk and minimally invasive, despite decades of critically appraised research establishing this test as the "psychological equivalent" of child sexual abuse (CSA).

Articles of Interest

VCUG Trauma -- long term effects and how to talk to your doctor??

On every single hospital website I have researched, this procedure is described as “uncomfortable but not painful.” I really fear coming across as unreasonable or dramatic here, but I can’t emphasize enough how false this is. It was incredibly painful.

Clinical Outcomes of Voiding Cystourethrogram and Antibiotic Prophylaxis

Despite the increased prophylaxis rate, UTIs were still observed in a significant proportion of children undergoing VCUG. Nevertheless, CAP has a significant role in reducing VCUG-associated UTIs. This calls for further research to identify additional risk factors, optimize prophylaxis strategies, and enhance the overall safety and efficacy of VCUG procedures in children.

Establishing a standard protocol for the voiding cystourethrography

The voiding cystourethrogram (VCUG) is a frequently performed test to diagnose a variety of urologic conditions, such as vesicoureteral reflux (VUR). The test results determine whether continued observation or an interventional procedure is indicated. VCUGs are ordered by many specialists and primary care providers, including pediatricians, family practitioners, nephrologists, hospitalists, emergency room physicians, and urologists. Current protocols for performing and interpreting a VCUG are based on the International Reflux Study in 1985. However, more recent information provided by many national and international institutions suggests a need to refine those recommendations.

Imaging after UTI—always a VCUG?

The purpose of the study was to identify children in whom VCUG, the most invasive and potentially problematic of the three studies, could be avoided. The take-home message was that ultrasound and DMSA had a sensitivity of 83% and a negative predictive value of 92% for identifying children with high-grade reflux.

The role of voiding cystourethrography in the investigation of children with urinary tract infections

Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25–40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution.

VCUG and the question of sedation

Increasingly, radiologists are being asked to provide some kind of pharmacological sedation or anxiolysis to make the experience even less stressful. Is this reasonable? Does the addition of sedative medication make for a “better” procedure? A safer procedure? A cost- and time-effective procedure? It is difficult to weigh these factors dispassionately, and there are strong opinions on each side.

VCUG and the recurring question of sedation: preparation and catheterization technique are the key

Unfortunately, many children have been irreparably traumatized by previous catheterizations as well as other invasive medical procedures and the mere thought of undergoing an unknown or repeat procedure is unbearable. I believe the use of sedation is entirely appropriate in these patients.

Voiding Cystogram

This examination is most commonly requested on children.

Voiding Cystourethrogram

A voiding cystourethrogram (VCUG), or cystogram, is a radiology study to evaluate the structure and function of the urinary system. This study uses a small amount of radiation and an x-ray machine to take pictures of the urinary system while the bladder is filled with liquid contrast material. The radiology images are then projected onto a computer screen and evaluated by the radiologist and your childʼs medical provider. There are two types of cystograms: voiding cystourethrogram (VCUG)/fluoroscopic or radionuclide cystogram (RNC). Both tests use have similar preparation and procedure, but use different radiological technique.

Voiding Cystourethrograms in Children: What's the Best Time?

These results indicate that unless a VCUG is obtained soon after a diagnosis of UTI, it may never be obtained at all. It appears safe and advantageous to perform a VCUG prior to discharge in children hospitalized with UTI.

What is a Nuclear VCUG?

We do the test by giving your child a radiopharmaceutical through a catheter in the bladder. This "tracer" is medicine combined with a small amount of radioactive material. It travels to the area of your child we need to see and is detected and imaged by a gamma camera. Radiopharmaceuticals are carefully tested. The risk of side effects is extremely small. Most radiopharmaceuticals used in nuclear medicine studies give less radiation exposure than a day at the beach.

What is a Voiding Cystourethrogram (VCUG)?

A voiding cystourethrogram (sis-toe-you-ree-throw-gram), or VCUG, is a video Xray of the bladder and urinary tract at work. The bladder stores urine made by the kidneys until it is time for your child to go to the bathroom. Filling the bladder with a special liquid that is visible on an X-ray enables the doctors to see how well the bladder and urinary tract are working.

Resources

RadiologyInfo.org

A pediatric voiding cystourethrogram (VCUG) uses fluoroscopy – a form of real-time x-ray – to examine a child's urinary bladder and lower urinary tract. Exam results allow your physician to determine whether your child's condition requires no therapy, medication, or surgery.