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Advances in Urology
Volume 2012 (2012), Article ID 716739, 8 pages
Review Article

Radiographic Evaluation of Children with Febrile Urinary Tract Infection: Bottom-Up, Top-Down, or None of the Above?

Division of Urology, Children's Memorial Hospital, 2300 Children's Plaza, P.O. Box 24, Chicago, IL 60614, USA

Received 26 April 2011; Accepted 14 June 2011

Academic Editor: Miroslav L. Djordjevic

Copyright © 2012 Michaella M. Prasad and Earl Y. Cheng. 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 proper algorithm for the radiographic evaluation of children with febrile urinary tract infection (FUTI) is hotly debated. Three studies are commonly administered: renal-bladder ultrasound (RUS), voiding cystourethrogram (VCUG), and dimercapto-succinic acid (DMSA) scan. However, the order in which these tests are obtained depends on the methodology followed: bottom-up or top-down. Each strategy carries advantages and disadvantages, and some groups now advocate even less of a workup (none of the above) due to the current controversies about treatment when abnormalities are diagnosed. New technology is available and still under investigation, but it may help to clarify the interplay between vesicoureteral reflux, renal scarring, and dysfunctional elimination in the future.