URINARY tract ultrasound demonstrated a low diagnostic yield in children following a first urinary tract infection (UTI), according to a retrospective cohort study of 1,460 children.
Researchers reviewed cases of children who underwent urinary tract ultrasound after a first UTI between January 2014 and December 2024.
The study aimed to determine how often ultrasound identified congenital anomalies of the kidney and urinary tract and whether findings influenced further investigation and treatment decisions.
Overall, 74.3% of children had a normal ultrasound examination, while 18.6% showed sonographic features consistent with acute infection.
Congenital anomalies of the kidney and urinary tract were identified in 6.9% of the cohort, but clinically significant abnormalities associated with urinary tract dilatation were detected in only 3.5%.
The most common clinically significant abnormality was vesicoureteral reflux, which was confirmed in 24 children, representing 1.64% of the study population.
Among children with urinary tract dilatation on ultrasound, vesicoureteral reflux accounted for 47.1% of cases.
Urinary tract dilatation was more common in males (6.0%) than females (2.7%). It was also more frequent among infants aged 0 to 6 months compared with older age groups.
Multivariable analysis showed male sex was an independent predictor of congenital anomalies associated with dilatation.
All children were followed for at least one year. During follow-up, 84 children with initially normal ultrasound findings or signs of acute infection underwent additional evaluation because of recurrent UTIs. Of these, 31 were diagnosed with vesicoureteral reflux.
Notably, 34 children with vesicoureteral reflux had normal findings on their initial ultrasound examination, highlighting the limited ability of urinary tract ultrasound to exclude reflux.
The investigators concluded that routine urinary tract ultrasound after a first UTI identified relatively few clinically relevant abnormalities and did not reliably guide decisions regarding reflux investigations.
The researchers suggested that a more selective imaging strategy should be considered.
Their data indicated that focusing initial imaging on male children and infants younger than 6 months could capture a large proportion of clinically significant abnormalities while reducing the overall number of ultrasound examinations.
They also proposed continued imaging assessment for children who experience recurrent UTIs.
Taken together, the findings suggest that a risk-based approach may improve resource utilisation while maintaining clinical safety in the evaluation of children after a first UTI.
Reference
Žvar T et al. Diagnostic yield of urinary tract ultrasound in children following a first urinary tract infection: a retrospective cohort study. Pediatr Radiol. 2026;DOI:10.1007/s00247-026-06729-5
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