Parent FAQs
Explore frequently asked questions from parents about pediatric VCUGs and vesicoureteral reflux (VUR) management.
Is it possible to sedate children during VCUG?
Yes, sedation has long been established as safe and effective for VCUGs. The most common argument against sedation during VCUGs is that the child “must be awake” to void, but sedation will NOT compromise test results when done correctly.
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To learn more about sedation and VCUG, we highly recommend reading this article by Dr. Karen Blumberg, MD, a pediatric radiologist with decades of experience.
“Sedation and pain relief are being offered for other minor procedures in hospitals such as intravenous access, lumbar punctures and suture placement. Radiology departments need to make similar changes as medical care evolves…Parents are aware of this and look to us to relieve their child’s pain and distress during these procedures.”
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“Conscious sedation utilizing either midazolam or inhaled nitrous oxide has been shown to be safe and to reduce distress in children undergoing VCUG without compromising the procedure results. The patients achieve sedation but are awake and able to respond to questions and to void.”
Are there alternatives to VCUG?
Yes, there are several safe alternatives to VCUG. For starters, the AAP guidelines specify performing a renal-bladder ultrasound (RBUS) prior to any VCUG (Alsaywid et al., 2023), which many providers fail to follow. This is an external, painless, non-invasive exam.
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If additional imaging is necessary, we highly recommend finding a practice that offers contrast-enhanced voiding urosonography (ceVUS). While this alternatives shares many of the same potentially traumatic elements of VCUG, it’s overwhelmingly preferred by parents for these reasons:
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It’s safer. Because ceVUS uses ultrasound, it’s 100% radiation-free. This eliminates the increased cancer risk associated with VCUGs (Liao et al., May 2014).
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It allows the child to void in a more natural position. During a VCUG, your child must void lying on their back beneath massive fluoroscopy machinery. ceVUS allows your child to void sitting upright—a more natural and dignified position.
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It’s more affordable. VCUGs are very profitable for hospitals, but can be burdensome for families. ceVUS saves families an average of $800 compared to VCUG, making it a more comfortable and cost-effective option for young patients.
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Superior diagnostic value. A big argument against ceVUS is its effectiveness, but compared to the gold-standard VCUG, ceVUS has an equal or superior diagnostic value.​
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You can explore other alternatives here.
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While every VCUG alternative has its pros and cons, we believe every parent is entitled to make informed decisions for their child’s unique health needs. Every patient is different and deserving of a custom treatment plan that caters to their specific situation.
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SOURCES: Marschner et al., Jan 2021; Marschner et al., Nov 2021; Sofia et al., July 2021; Seelbach et al., Feb 2022; Roic et al., June 2023; Kapral et al., July 2023
How much radiation is used for VCUGs?
We don’t know. After nearly seven decades of VCUG performance, there is still no standardized protocol for VCUG referral, performance, or follow-up. Research shows that radiation doses and VCUG protocols “vary widely” between institutions.
“A recent survey of 65 children's hospitals throughout the United States and Canada showed that VCUG protocols vary substantially. Recent guidelines from the American Academy of Pediatrics (AAP) […] did NOT specify how this test should be performed” (Frimberger et al., 2016).
Is radiation actually a negligible risk of VCUG?
No. As early as 2009, researchers assert that radiation is NOT a negligible risk of VCUG. This is largely because 1.) there are no standards, let alone enforcement or professional accountability, regarding radiation exposure during VCUG, and 2.) “the risks associated with radiation exposure are higher in children than in adults” (Lee et al., June 2009).
Does a VCUG treat kidney reflux/VUR?
No. VCUGs are strictly diagnostic and do NOT treat vesicoureteral reflux (VUR). The only purpose of a VCUG is to confirm or rule out a VUR diagnosis. Depending on the circumstances, VUR treatment may include antibiotics, corrective valve surgery, or a combination of both.
Test your knowledge
Put your VCUG knowledge to the test by taking our TRUE/FALSE quiz below.
True/False Quiz
#1. ceVUS is a radiation-free alternative to VCUG, but its diagnostic value is poor.
#2. VCUGs are associated with an increased cancer risk, especially in the genitourinary system.
#3. VCUG is the gold-standard treatment for vesicoureteral reflux (VUR).
#4. Children are much more sensitive to ionizing radiation than adults.
Answer Key
True/False Quiz
#1. ceVUS is a radiation-free alternative to VCUG, but its diagnostic value is poor.
ceVUS is shown to have an equal or superior diagnostic value compared to its “gold-standard” counterpart: “Experts now generally consider ceVUS to have similar (if not slightly higher) diagnostic performance to VCUG” (Cajigas-Loyola et al., June 2024).
#2. VCUGs are associated with an increased cancer risk, especially in the genitourinary system.
#3. VCUG is the gold-standard treatment for vesicoureteral reflux (VUR).
VCUGs are strictly diagnostic. They do not “treat” any medical condition. Their sole purpose is to confirm or rule out a VUR diagnosis.
#4. Children are more sensitive to ionizing radiation than adults.
“Children's developing tissues and organs are approximately 10-fold more sensitive to ionizing radiation than adults, and mean risks for hereditary effects and cancer after VCUG during childhood have been estimated at 15 per million and 125 per million, respectively. Thus, radiation risks associated with VCUG are not negligible” (Johnin et al., Feb 2019).