To evaluate vesicoureteral reflux in a child with recurrent UTIs, what test may be performed?

• A. Voiding cystourethrogram (VCUG) after urinalysis
• B. Abdominal ultrasound
• C. MRI
• D. CT urogram

Answer: (A)

To detect vesicoureteral reflux, you need a study that directly shows urine moving backward from the bladder into the ureters during voiding. A voiding cystourethrogram does exactly that: a catheter is used to fill the bladder with radiopaque contrast, and X-ray images are taken as the child voids. If the contrast is seen traveling back up into the ureters or kidneys, reflux is present, and the finding can be graded to help determine management. This test is especially useful in children with recurrent UTIs to identify VUR and assess potential renal involvement, and it’s typically performed after urinalysis confirms a UTI so the test is appropriately targeted.

Ultrasound can reveal structural issues like hydronephrosis or renal scarring but does not reliably detect reflux. MRI and CT urograms aren’t first-line for evaluating VUR; they’re not as practical or specific for this purpose and CT involves radiation.