Are There Alternatives to VCUG?
- Unsilenced
- Mar 31
- 5 min read
This information is for general knowledge and informational purposes only, and does not constitute legal or medical advice. Always consult with a qualified professional for any questions or concerns you may have.
While the voiding cystourethrogram (VCUG) procedure is the longstanding gold-standard diagnostic test for vesicoureteral reflux (VUR) in children, its high potential for sexual and medical trauma has led many parents and patients to explore alternative examination methods.
Contrary to popular belief, there are several safe alternatives to voiding cystourethrograms (VCUGs) in pediatric urology. Sadly, parents are rarely informed of alternative measures even when they may be suitable for their child’s unique health needs.
Being informed of available alternatives (including no treatment) is a critical component of the informed consent doctrine. At the Unsilenced Movement, we believe every parent is entitled to give informed consent for their child’s medical care.
In this blog, we review five lesser-known alternatives to VCUGs to guide parents in informed decision-making for their child’s unique health needs.
Alternative Examinations for Voiding Cystourethrograms (VCUGs)
While VCUGs are the most widely accepted diagnostic test for VUR, every child has unique health needs. What works best for one pediatric patient may not work well for another, and vice versa. This isn’t to say that VCUGs aren’t an effective diagnostic method; on the contrary, we believe parents reserve the right to consent to a VCUG or an alternative method.
Often, parents are told that their child will die without a VCUG (and potential annual follow-up VCUGs). However, parents are rarely informed of alternative testing that is safe and available.
Regardless of what providers believe about the gold-standard VCUG, this does not justify the lack of disclosure of safe, available alternatives. Informed consent is only obtained when families are fully informed of their options. This includes all reasonable information about a proposed treatment method, including foreseeable risks and alternative options.
Below are some alternative diagnostic methods for VCUG:
1. Contrast-Enhanced Voiding Urosonography (ceVUS)
Perhaps the most promising alternative to VCUG is contrast-enhanced voiding urosonography, or ceVUS. ceVUS uses a special contrast agent to image the urinary tract without radiation. While this procedure is performed similarly to a VCUG, there are some key differences—most notably, the lack of ionizing radiation.
Other advantages include cost-effectiveness (approximately $800 cheaper than a VCUG examination), improved comfort (the child is permitted to void in the natural upright position), and parental support (parents can stay at their child’s side due to the lack of radiation).
Radiation amount: None.
Diagnostic value: Equal or greater than VCUG.
Limitations: Despite its advantages, ceVUS is rarely offered at most hospitals.
Catheterization required? Yes.
Voiding required? Yes.
Sources: Marschner et al., 2021a; Marschner et al., 2021b; Sofia et al., 2021; Seelbach et al., 2022; Roic AC et al., 2023; Kapral et al., 2023; Cheng et al., 2023; Hutchinson et al., 2023; Biswas et al., 2024; and Cajigas-Loyola et al., 2024.
2. Computed Tomography (CT) Urogram
A CT urogram is an advanced imaging technique that uses X-rays to create detailed cross-sectional images of the urinary tract, including the kidneys, ureters, and bladder. An intravenous (IV) line is placed into a vein in the hand or arm, through which the X-ray dye will be injected. The patient will lie on a table for imaging.
This examination is painless, non-invasive, and accurate. While CT urography is not a primary method for diagnosing VUR because it doesn’t dynamically assess urine flow, it can identify urinary tract abnormalities and signs of VUR, making it a potentially suitable alternative for some patients. The lack of urethral catheterization associated with VCUGs can also reduce the risk of sexual trauma.
Radiation amount: Significantly higher than VCUG.
Diagnostic value: Excellent for high-resolution, comprehensive imaging.
Limitations: Not a primary VUR diagnostic tool and requires more preparation than a VCUG (e.g., less profitable for clinics and hospitals).
Catheterization required? No.
Voiding required? No.
3. DMSA Renogram (Dimercaptosuccinic Acid Renogram)
The DMSA renogram is invaluable for assessing kidney health, particularly in cases involving kidney scarring or damage from recurrent UTIs or VUR. Unlike a VCUG, the DMSA scan doesn't require the child to void or experience invasive catheterization during the test. Instead, it uses nuclear medicine imaging with a radioactive tracer injected intravenously.
Radiation: Lower than VCUG.
Diagnostic value: Excellent detailed imaging of kidney function/renal scarring.
Limitations: Does not directly show VUR.
Catheterization required? No.
Voiding required? No.
4. MAG3 Renal Scan
The MAG3 renal scan evaluates kidney function, drainage, and potential obstructions. A radioactive tracer called MAG3 (Mercaptoacetyltriglycine) is injected into the bloodstream through an IV. A catheter may be necessary to keep the bladder empty during the scan.
Radiation: Lower than VCUG.
Diagnostic value: Excellent imaging of kidney function/drainage.
Limitations: Does not directly visualize VUR.
Catheterization required? Possibly.
Voiding required? No.
5. Intravenous Pyelogram (IVP)
An intravenous pyelogram (IVP) uses an intravenous contrast agent to image the kidneys, ureters, and bladder.
Radiation: Higher than VCUG.
Diagnostic value: Excellent imaging of kidney structure and function.
Limitations: Does not directly visualize VUR.
Catheterization required? No.
Voiding required? Yes.
Choosing the Right Diagnostic Method for Your Child
While VCUGs may be perfectly appropriate for VUR diagnosis in many circumstances, this isn’t the case for every child—especially for those with non-VUR urinary tract abnormalities. In some cases, VCUGs can miss important urological conditions that necessitate the same prompt treatment as VUR (such as ectopic ureters).
While the VCUG test is promoted as life-saving, VCUGs do not treat VUR or any other urological condition. For this reason, the right examination method for a child’s diagnosis will inevitably vary from family to family, depending on the patient’s symptoms, health needs, and unique biological factors. Seeking collaborative, patient-focused care from a trauma-informed provider is critical to determine which procedure is most appropriate for your child.
Empowering Parents to Exercise Their Right to Informed Consent
To those who advocate for the gold-standard VCUG in any and every circumstance, we ask: At what cost? For many children, the widely misunderstood and long-lasting health effects of one or more "life-saving" VCUGs in early childhood are equally or more detrimental to their health. In many cases, opting for an alternative diagnostic exam may reduce the negative health outcomes associated with VCUGs.
At the end of the day, only patients and their loved ones have the right to decide what is best for their comprehensive health—physically, emotionally, spiritually, and mentally. While VCUGs can provide life-saving diagnoses, there is much unsaid about the chronic and life-threatening complications of VCUG, including self-harm, suicidality, child sexual abuse (CSA) symptoms, complex trauma/PTSD, and lifelong refusal of medical care and cancer screenings.
Join the Unsilenced Movement
As a parent, only you know what’s best for your child. Understanding all the options available to you and weighing the pros/cons of each diagnostic method is essential—not just to protect your child’s immediate well-being, but to safeguard their long-term health as adults.
At the Unsilenced Movement, we believe that every child deserves a tailored treatment plan that is just as unique as they are. This can only happen when families are informed of all diagnostic methods and treatment options.
Our organization is committed to equipping patients and parents with the tools and support they need to navigate the emotionally and financially taxing journey of VUR diagnosis and treatment. Whether you’re currently awaiting a diagnosis for your child or recovering from VCUG trauma as a former patient, our community is a safe space to connect, learn, and heal.
No matter what led you here today, you’re not alone. Join the Unsilenced Movement to connect with fellow survivors and take the first step toward VCUG trauma recovery.
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