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Advances in Urology
Volume 2009 (2009), Article ID 783409, 5 pages
Review Article

The “Top-Down” Approach to the Evaluation of Children with Febrile Urinary Tract Infection

Division of Urology, Children's National Medical Center, Washington, DC 20010, USA

Received 4 June 2008; Revised 10 November 2008; Accepted 24 January 2009

Academic Editor: Darius J. Bagli

Copyright © 2009 Hans G. Pohl and A. Barry Belman. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The evaluation of children presenting with urinary tract infection (UTI) has long entailed sonography and cystography to identify all urological abnormalities that might contribute to morbidity. The identification of vesicoureteral reflux (VUR) has been of primary concern since retrospective studies from the 1930s to 1960s established a strong association between VUR, recurrent UTI, and renal cortical scarring. It has been proposed that all VUR carries a risk for renal scarring and, therefore, all VUR should be identified and treated. We will not discuss the controversies surrounding VUR treatment in this review focusing instead on a new paradigm for the evaluation of the child with UTI that is predicated on identifying those at risk for scarring who are most deserving of further evaluation by cystography.