For generations, medical professionals—particularly those in pediatrics and women’s healthcare—have repeatedly violated patients’ rights and bodies. Unfortunately, the U.S. healthcare system leaves much to be desired in terms of transparency, informed consent, and overall respect for bodily autonomy.
Women, children, and BIPOC in particular can have tremendous difficulties receiving proper, ethical care, from performing pelvic exams on unconscious women at teaching hospitals to decades-long sexual abuse by renowned and well-respected pediatricians. Unfortunately, gaps in the healthcare system continues to open the door to lasting harm and continued abuse of power.
This is especially true about voiding cystourethrogram (VCUG) tests, the current “gold standard” for diagnosing vesicoureteral reflux (VUR) and kidney problems in children.
VCUG: Fact or Fiction?
While it can be challenging to separate fact from fiction when seeking medical care for yourself or your child, it’s imperative for parents and families to work together to create a safer space for children’s healthcare—one that upholds moral and ethical standards, including informed consent and access to reliable, trauma-informed pediatric care.
Below are 3 chilling truths about pediatric VCUG:
1. VCUGs may involve multiple bladder fillings in catheterize children with painful UTIs.
Retrograde voiding cystourethrography with contrast medium, including VCUGs, came into widespread use in the late 1950s, when fluoroscopes with image intensification and cine recording became generally available.
One 1989 study in Quebec, Canada sought to establish how reliable VCUG testing is by examining the results after a single bladder filling vs. second and third fillings in children undergoing VCUGs. Only a handful of kids (12.43%) demonstrated any discrepancy in VCUG test results. “By no means do we advocate multiple fillings,” the researchers emphasized.
Although the study was completed in 1989, not much has changed. In 2023, VCUG conductors routinely administer multiple bladder filling and voiding in pediatric VCUG patients. For the most part, parents are not notified by any medical professional regarding the risk of urinary bladder rupture during VCUGs.
2. Children suffer urinary bladder rupture as a result of VCUG.
While urinary bladder rupture isn’t a common effect of VCUG, it’s certainly worth mentioning. One 2007 study revealed that 32.7% of VCUG patients showed complications following VCUG, including urinary bladder rupture and UTIs.
“We also found that prophylactic antibiotic use did not prevent urinary tract infection nor decrease the rate of complications associated with VCUG,” the study confirms.
Another 2012 study describes a healthy 9-month-old little girl who underwent a successful VCUG, only to be rushed to the operating room for emergency care. “Urine, blood clots, and contrast media were evacuated from the peritoneum,” the study explains.
The little girl suffered urinary bladder rupture during the VCUG, sustaining a tear that was 3 centimeters long.
What went wrong? “In this case, the main causes of bladder rupture are considered to be the use of the Foley catheter instead of a feeding tube, manual injection of contrast media, and the excess volume instilled more than expected volume,” the study explains.
Such errors aren’t limited to special circumstances, either. They can apply to any VCUG. Regardless of how rare urinary bladder rupture is during VCUG, this is an extremely serious risk that MUST be disclosed to parents and families before legally effective informed consent can be obtained.
3. VCUG is a highly standardized test—without standardized protocol.
With multiple countries consistently promoting VCUGs as safe, painless, low-risk, and minimally invasive, there is shockingly little uniformity to how this “gold standard” test is performed on children, with the vast majority of patients being infants, toddlers, or preschool-aged…tiny, vulnerable humans with no voice of their own.
As a parent, it’s time to start asking questions about the protocol surrounding pediatrics VCUGs. In the study detailing the 9-month-old’s bladder rupture, researchers identify certain factors that VCUG conductors must pay attention to if they wish to perform the procedure safely.
“To perform a safe VCUG, we should pay attention to factors such as bladder volume, the patient’s underlying disease, the velocity of the contrast instilled, and catheter size,” researchers urge. “The bladder volume is different among individuals, and the bladder dome which is the weakest part of bladder can easily be ruptured when excess volume is injected rapidly.”
“The literature has shown significant variability among institutions regarding the VCUG protocol used, as well as inconsistent reporting of the findings from the VCUG between institutions,” says another 2019 study.
A 2017 study agrees, noting that few standards exist for reporting VCUG findings. After creating a standardized assessment tool—a 23-item checklist—to evaluate reporting of technical, anatomic, and functional information from VCUGs, they analyzed 602 VCUG tests performed at 90 different medical institutions. Less than half of the standardized items were included in VCUG reports.
"The literature has shown significant variability among institutions regarding the VCUG protocol used, as well as inconsistent reporting of the findings from the VCUG between institutions."
“There is a substantial underreporting of findings in VCUG reports,” the study warns. “Although VUR was often reported, other crucial anatomic and functional findings of the VCUG were consistently underreported across all facility types.”
Holding VCUG Conductors Accountable for Children’s Care
It’s no secret that generations of children have been needlessly traumatized by VCUG. For decades, this “gold standard” procedure has been over-performed, improperly performed, and falsely promoted, leading to serious long-term health issues in countless adult survivors of pediatric VCUGs. Worse, pediatric VCUGs are widely promoted as safe, routine, and forgettable—a picturesque lie that many Unsilenced Survivors describe as “a walk in the park” when torture is a far better way to describe the reality.
You’re not alone.
Join the fight to hold medical organizations accountable for longstanding negligence in pediatric care. Contact us online to find support for yourself or a loved one recovering from VCUG trauma.
Two words that make my blood boil: 'gold standard'.